Network Representative

ChenMed•Mechanicsville, VA

6d•$59,251 - $84,643•Onsite

About The Position

The ChenMed Network Representative is responsible for establishing and maturing collaborative relationships with the preferred specialists to whom we refer our patients and ensuring external referrals adhere to this network. The Network Representative engages preferred specialists as the market’s point of contact and coordinates among the specialists and our ChenMed clinical, operations, and Referrals teams. This person will understand drivers of specialist behaviors and translates these into actions improving patient care and collaboration while reducing medical costs. The person is also the main market Network liaison for operations, clinical, Referrals, Hospital and Community Care Team, Specialty and Medical Centers of Excellence, and Health Economics teams. This role works with the Network Director to develop strategies and tactics for strengthening existing specialist relationships, identifying key opportunities for new providers to join the preferred network, and managing poorly performing specialists out of the preferred network. The Network Representative will leverage ChenMed resources including referrals, claims, and medical cost data and qualitative market intelligence yielding key insights to optimize patient outcomes, simplify care complexity, and reduce costs of care through a robust, high-performing preferred specialist network. Preferred provider network knowledge and insights will be used to educate clinical, Referrals, and operations teams about the preferred network, referrals adherence, and medical cost opportunities and outliers.

Requirements

Advanced-level business acuity
Comprehensive knowledge and understanding of general/core job-related functions, practices, processes, procedures, techniques, and methods
Advanced skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in other systems required for the position
Ability and willingness to travel locally, regionally and/or nationally up to 80% of the time; flexible to work evening, weekends and/or holidays as needed
Team-oriented with the ability to work extremely well with patients, colleagues, physicians, and other personnel in a professional and courteous manner
Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks
Spoken and written fluency in English
This job requires use and exercise of independent judgment
BA/BS degree in Healthcare or related field is required OR additional experience above the minimum may be considered in lieu of the required education on a year-for-year basis
A minimum of 3-5 years’ work experience in Healthcare or related field is required
A valid, active driver's license in State of employment is required; position may require travel within the market

Nice To Haves

Healthcare experience within the Medicare HMO population is a plus
Prior experience working in a Medicare Managed Care environment preferred

Responsibilities

Curation and management of the preferred specialty provider network in consultation with internal stakeholders
Building relationships with preferred specialty providers to drive their behaviors and gaining mutually beneficial commitments to progress specialist relationships through the maturity framework
Frequent rounding with preferred specialty providers leveraging analytics resources to inform about shared goals, collaboration, communication, referrals, medical cost performance, and levels of service
Direct accountability for referrals adherence to the preferred specialty provider network
Communication and education with clinical, operations, Referrals, and Specialty and Medical Centers COEs about the specialty network
Collaboration with Health Econ and Specialty and Medical COEs to analyze medical cost opportunities for interventions within the Network scope
Participate in Center clinical and operational meetings, e.g., Transforming Care Meetings (TCMs), to gain specialist network feedback and provide Network and medical costs education
Drive preferred specialist network adherence by collaborating with Center Dyads and Referrals to analyze, identify opportunities and support improvement initiatives within Referrals including workflow, productivity, leakage and consult tracking
Proactively and independently manage specialist network plans of action, analytics needs, and rounding schedules
Agility to adapt strategies and tactics to changing market and company dynamics
Examine obstacles from various perspectives to develop new and creative solutions when other attempts fail
Strong communication and presentation skills
Support communication and collaboration with health plans at the city/area and regional levels
Performs other duties as assigned and modified at the Network Director’s discretion