Manager of Provider Relations

Metroplus Health Plan Inc•New York, NY

57d•Hybrid

About The Position

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Manager of Provider Relations will serve as the point person for managing the day-to-day relationship between MetroPlusHealth and top level administrators at each assigned network facility and community providers. Responsible for overall provider satisfaction regarding assigned network segment and will manage respective network support team.

Requirements

Bachelor's degree, preferably in health care administration, and a minimum of 5 years experience in healthcare, plan or provider operations/administration/ relations or related area.
Strong customer service experience with proven ability to build and maintain provider relationships
Managed care, value-baed payment model, quality and population health management experience
Knowledge of principles of business and personnel administration, management functions and support service functions and ability to direct and supervise personnel
Proficiency with Windows-based PC systems and Microsoft Office, Sharepoint
Ability to travel to meet with Providers and their representatives
Integrity and Trust
Customer Focus
Functional/Technical skills
Excellent written and communication skills; ability to deliver complex information and achieve positive results
Energetic, goal driven leader with who can motivate and mobilize staff to achieve goals.
Strong problem-solving capabilities
Highly organized, detail oriented, dependable and professional individual

Nice To Haves

Master's degree in Health Administration preferred

Responsibilities

Act as a key resource to external providers and internal key stakeholders as it pertains to operational issues impacting assigned network segment.
Responsible for day-to-day business activities and managing provider relationships.
Cultivate strong partnership with assigned network facility and community providers.
Develop and implement educational processes and pro-active solutions for payment and other provider operations requirements as well as access & availability concerns
Reviews reports on annual provider satisfaction surveys; ensures the development of plans to improve identified areas of concern; work with other departments to develop quality assurance initiatives based on survey results.
Ensure segment's data integrity of provider directory, web search, etc.,
Monitor/Trend Provider calls received as well as any complaints received for responsible segment
Develops processes to educate new and existing providers regarding their contractual responsibilities as well as policies and procedures.
Monitor provider concerns, collaborate and consult with internal leaders and department to improve operations and resolve issues impacting provider satisfaction and payment.
Participates in cross-functional workgroups to understand impact of plan changes and initiatives on provider network, advocating for providers as appropriate
Ensure timely responses to regulatory agencies (i.e., NYSDOH, DFS) in response to all Provider Network regulatory and compliance issues
Facilitate with marketing and retention department management to identify opportunities in current provider locations and cultivate them in viable prospects to increase MetroPlusHealth enrollment and retention efforts.
Coordinate events with the community/government agency offices within assigned network
Working collaboratively with Account Management Team, build strong partnership with provider community by cultivating open communication and ensuring Account Leads are aware of provider pain points relative to claims disputes.
Attend Joint Operating Committee meetings and takes ownership of resolving issus with assigned hospitals, etc.
Develops policies and procedures, process improvement initiatives
Manage and mentor staff to ensure job functions are completed appropriately and according to priorities
Coordinates department's efforts with those of other departments
Performs other support activites and duties as assigned