The Manager of Provider Relations is responsible for developing and maintaining strong provider relationships, growing network competencies, and ensuring provider related regulatory readiness for all US Family Health Plan and CHRISTUS Health Plan product lines in accordance with the Provider Network Strategy. Through oversight of regionally based Provider Relations Representative and Engagement Consultants, the PR Manager will report out regularly on productivity, provider engagement, and progress on special initiatives.
- Manages and directs the administrative functions relating to contracted provider network, including provider training, establishing and improving provider relationships, optimizing provider utilization and overall provider communications. Internal liason for Database, Claims, Customer Service, Medical Management, and Quality Management Departments. Management of external provider relations staff of 6.
- Provider Orientation and Training: Responsible for New Provider and Staff Orientations and contining education of existing providers to ensure company programs, initiatives, and processes are being effectively communicated and followed by the provider network. Ensure providers are effectively utilizing company tools available to them. Develop and implement effective market-based provider orientation, training, and education programs for new and existing providers anticipating future growth of the health plan into different product lines. Coordinate all aspects of provider training to meet network needs and/or State requirements. Trainings may be conducted in various in-person, web-based, and pre-recorded training platforms to small and large audiences. Collaborates with other internal departments (e.g. Clinical, Claims, Quality) to identify, develop and deliver the accurate training content.
- Provider Questions/Issues/Claims: Works closely with operational managers to identify provider problems/ complaints and develops and implements a course of action to resolve concerns. Develops analytics to track and communicate trends and root causes.
- Policies and Procedures: Develop systems, policies and procedures to communicate and ensure successful integration and engagement of contracted providers. Ensures health plan compliance with regulatory network requirements by monitoring provider communication and education needs including requisite reporting needs.
- Provider Communication: Responsible for creation and maintenance of Health Plan Directories, Provider Newsletter, Provider Manual, and Provider Satisfaction Surveys.
- Directories: Oversee quality and production of print and online directories for all lines of business and all markets including management of regulatory standards, frequency, and deadline. Monitor and manage quality of provider data represented in directories. Work with market leaders and sales/marketing to address market specific needs and preferences for outward facing directory materials especially around annual enrollment periods. Ensure provider information, adds, terms, changes are accurately and timely updated in provider databases. Support efforts on new developments or modifications of provider database or applications
- Manuals: Oversee quality and production of Provider Manuals ensuring that all sections are up to date and complaint with relevant regulatory guidelines and standards. Collaborate with department leads to ensure that content areas are reviewed and maintained regulary to keep up with the ever changing health care landscape. Ensure that resources and notices are made available to providers in line with regulatory expectations.
- Quick Resource Guides: Support provider network by maintining materials that give them quick access to department contact information and health plan resources. Ensure accuracy of data to promote a positive image of the health plan among the network provider community.
- Provider Quality: Responsible for the oversight of each market to ensure network provider deficiencies are being met. Monitors operational performance via Provider Relations staff productivity metrics, Provider education/visits metrics, Provider satisfaction results/metrics, Provider complaints and appeals metrics, Provider access requirements/metrics/results (corrective action plans), and contractual compliance.
- Provider Portal: Assists contracted providers, groups, and facilities access pertainent information via online provider portal. Tracks and trends portal usage and develops reporting for communicaiton to leadership. Monitors portal issues and downtime assessing root cause to reduce future downtime.
- Staff Development: Knows and follows the employee handbook policies and procedures. Responsible for coordinating subordinate recruitment, selection and training, performance assessment, work assignments, salary, and recognition and discipline process. Develop training materials for provider related training of staff. Assists in the development and implementation of policies and procedures, internal workflows and other tools for staff training and complaince.
- Development Support: Identification, recruitment, and basic contracting of providers where additional support is needed
- Education: Bachelor's Degree Business Administration, Healthcare Administration or a related field and exemplary experience required. Master's Degree in Business Administration, Healthcare Administration or a related field preferred.
- Strong presentation, analytical and organization skills.
- Effective oral and written communication skills.
- Seven (7) or more years of significant experience in provider relationship management. Ten (10) or more years preferred.
- Knowledgeable and compliant with all relevant laws, rules regulations, accreditation standards and requirement.