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Provider Services Manager

Healthcare Highways, Inc.

Provider Services Manager

Baton Rouge, LA
Full Time
Paid
  • Responsibilities

    Job Description

    ROLES AND RESPONSIBILITIES

    The Provider Services Manager will serve to drive provider performance improvement through practice and provider engagement. This includes the education of practices on value-based incentives, benefit design, provider reporting and other program elements that support them in the delivery of high-value care to members. This position will work with provider practices along with cross functional internal teams on initiatives designed to increase the delivery of quality care and reduce the overall total cost of care for provider’s patients.

    RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO:

    • Coordinate all provider services functions including practice education, performance reporting, provider updates and on-going practice assessment as assigned.
    • Assure that all provider orientations, practice visits, practice assessments are completed within designated timeframes.
    • Analyze network practices regularly for provider accessibility, care coordination capabilities, enabling technology and industry best practices.
    • Assist with the development of policy and procedures related to value-based incentives and other shared risk and gain sharing programs.
    • Provides direction and training on policy and procedures to each of the providers in a value-based incentive agreement.
    • Work cohesively with clinical management staff to reinforce strategic and tactical initiatives with the ACO/PCMH providers.
    • Works with marketing department on development of provider communications including practice education on value-based incentives and member benefits.
    • Manages and monitors provider score card results.
    • Supports network and credentialing teams in ensuring provider database and documentation is up-to-date, accurate, and complete.
    • Collaborate with quality team to assist in development and implementation of practice training programs.
    • Investigate and resolve provider complaints related to member attribution, provider reporting and incentive payments to maintain provider satisfaction.
    • Proactively identify provider needs and advise leadership, so that action can be taken to address the needs before they are problematic for the provider.
    • Assure that applicable operating policies, procedures, and standards are followed.
    • Always represent the organization well; support its mission, goals and objectives; participate as a “team player”, constantly supporting other managers; set an example of high personal and professional conduct for employees and others.

    QUALIFICATIONS

    • 5-7 + years in the health care industry including experience supporting providers in risk-based contracts
    • Strong work management skills - identify a goal and the steps needed to accomplish and proactively manage action steps to reach goals.
    • Demonstrated understanding and subject matter expertise within any the following areas: Medicare advantage, Medicare Shared Savings Program (MSSP), managed care regulations, quality reporting, care management, population management, practice transformation, ACO and patient centered medical home (PCMH) operations.
    • Demonstrate excellent organizational skills.
    • Demonstrate effective verbal and written communication skills.
    • Demonstrate high attention to detail and a high degree of accuracy.
    • Ability to develop and maintain deep expertise of Healthcare Highways products and best practices
    • Advanced knowledge of the U.S. healthcare system
    • Strong interpersonal communication, collaboration, presentation and training skills.

    EDUCATION REQUIREMENTS

    • Bachelor degree or equivalent experience required.

    Company Description

    Founded in 2010, Healthcare Highways is a health plan backed by a high-performance network that delivers quality care, cost savings, and sustainable value. We're the new competitor in health care working with employers of large, small, and hourly workforces to get the most value out of their health plans and the best health outcomes for all members. We believe in being transparent about costs, coverage, care and our relationships. We believe independent healthcare providers should influence where and how patients are treated. We believe ensuring quality care is our non-compromising obligation, and that health outcomes are its only means of measure. We view competition as the catalyst with which to bring about the innovation industry needs to drive down costs and drive up quality care. We believe we are bringing that competition.