Community Supports Provider Relations Manager

Inland Empire Health Plan•Rancho Cucamonga, CA

8d•Hybrid

About The Position

Reporting to the Manager of Community Supports, the IEHP Community Supports Provider Relations Manager (CS PRM) is responsible for developing and maintaining a robust network of potential and contracted Community Supports network providers to ensure service adequacy, quality, and compliance with federal, state, and local regulations. This role serves as the primary liaison and subject matter expert for all CS services associated with their assigned providers, fostering strong partnerships to drive operational excellence, facilitate redesigning efforts, introduce population health initiatives, and support achievement towards clinical outcomes and value-based care. The incumbent serves as the primary point of communication with the CS Provider and maintains oversight of the relationship from inception of the CS Provider’s relationship with IEHP onwards. The CS PRM leads provider engagement, onboarding, training, and performance improvement efforts, while supporting strategic initiatives to expand and strengthen the Community Supports network in alignment with IEHP’s mission and strategic goals. In addition, the CS PRM is responsible for recruiting new CS Providers into IEHP Community Support Network as well as identifying opportunities to develop the Community Supports network to meet IEHP quality metrics, service goals, and compliance standards. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Requirements

Three (3) or more years of experience with customer service in a health services setting including Hospital, Managed Care, Medical Group, IPA, and/or HMO
Experience with managed care
Experience working in the community with community-based organizations (CBO’s)
Bachelor's degree from an accredited institution required
In lieu of the required degree, a minimum of four (4) years of additional relevant work experience in Community Supports is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above.
Must have a valid California Driver’s license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.
Knowledge of Community Support Services
Working knowledge of Medical Group, IPA, CBO’s and HMO operations
Proficiency in utilization of all Provider Services databases and systems
Strong organizational skills. Excellent written and verbal communication and interpersonal skills
Microcomputer Applications (Microsoft Word and Excel, Access Preferred) for use in all aspects of an office environment
Skilled data input
Skills in proactively engaging with providers and staff to determine root cause and address business issues (such as administrative, regulatory and customer service matters)
Training skills to educate providers and provider staff as needed, which may include counseling providers diplomatically, while retaining a positive working relationship
Skills in network development, by monitoring and enforcing company policies and procedures, while increasing Provider effectiveness by educating and promoting participation in various IEHP initiatives
Proven ability to: Provide clear directions, set expectations, and motivate community partners to achieve goals
Make informed, timely decisions using data, judgment, and stakeholder input
Communicate clearly both verbally and in writing - with diverse audiences
Build strong trust-based relationships with partners and stakeholders
Demonstrate a strong sense of ownership of IEHP’s relationship with the Provider that recognizes the Provider as a valuable partner
Independently troubleshoot and problem-solve issues as they arise, making an assessment when escalating to a CS Manager, Director, or another IEHP department as needed and initiating, coordinating, and participating in problem-solving meetings between the Provider and IEHP stakeholders, including senior leadership and Providers
Take initiative in preventing and resolving issues between the Provider and IEHP whenever possible
Independently deliver training and presentations to assigned Providers and their staff, answering questions that come up on behalf of IEHP. May also deliver training and presentations to larger groups, such as leaders and management of Provider offices

Nice To Haves

Master’s degree from an accredited institution preferred
Examples of such initiatives include administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, IEHP Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.)

Responsibilities

Establish and maintain Meaningful Engagement cadence with contracted and potential CS providers through regular in-person, telephonic, and virtual meetings. Provide Strategic Engagements with CS Providers as requested by other IEHP Departments, including but not limited to Quality, Health Education, Health Services, and Strategy.
Serve as the primary point of contract for assigned providers, addressing operational needs, providing CS-specific content, escalations, and strategic initiatives.
Maintain accurate and timely log of Provider visits in compliance with NCQA standards, and DHCS and CMS regulatory requirements.
Recruit and onboard new CS Providers into IEHP CS Network Service using data-driven strategies, market analysis, and/or other comparable methods. Manage New CS Provider On-Boarding Checklist activities. Ensure all vetting/onboarding tools are accurately updated accordingly.
Facilitate in service sessions for potential Community Supports providers, presenting program expectations, goals, performance metrics, and DHCS reporting requirements to executive and senior leadership stakeholders. Develop and deliver training materials for staff Executive level staff, both contracted and non-contracted CS Providers on CS requirements, workflows, reporting and system tools.
Deliver training and technical assistance to providers on program requirements, workflows, and reporting.
Facilitate corrective action plans and performance improvement initiatives to address gaps in service or compliance.
Lead provider meetings, training, and workgroups focused on improving program performance and data quality.
Lead contracting activities for new CS Providers and assist with re-contracting processes. Take lead in obtaining all contracting collateral as required for new CS Providers.
Collaborate with Contracts and Credentialing Departments to ensure timely completion of required documentation. Address Provider inquiries concerning rate/service changes and claims disputes.
Ensure provider adherence to DHCS reporting requirements, data submission protocols (i.e., Secure File Transfer Protocol (SFTP)), infrastructure, and IEHP standards around CS services.
Identify opportunities for growth and partnership while working with CS Providers. Partner with CS providers to implement the growth initiatives.
Monitor provider performance through reviewing encounter data, reporting, documentation, and adherence to compliance requirements.
Promote ethical standards and maintain proficiency in IEHP programs, policies, and procedures as they relate to the Providers of IEHP, including IEHP lines of business and member benefits.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.