Provider Network Manager

RHC Group Management LLC • Nashville, TN

1d

About The Position

Revere Medical gives new life to clinics in need of tools resources, and support so they can start delivering the personalized care their communities deserve. We’re committed in supporting our colleagues by offering competitive benefits that contribute to your overall well-being.

What You Will Do:

In collaboration with Revere Medical’s leadership, leverage the clinical volume tracker, risk claims data, Athena referral data and other pertinent data to identify the service lines where the largest area of opportunity (and highest impact) to improve care coordination
Engage providers, share specific data points and document obstacles / needs in the care coordination tracker
Present obstacles / needs to the local team and work to address collaboratively then report out to the leadership team on status and if further support is needed
Review and report out trended performance making sure improvement is being made
Monitors the availability of in network service gaps that need to be filled to keep patient care services in the Revere Medical system and proactively manages physician and key leadership relationships and brings critical issues leaderships attention
Collaborate with clinical, quality, and risk adjustment leaders to develop strategies and actions to improve provider group/ network performance as needed
Advise market leadership and Regional Network Director of providers who are at risk of leaving the network and develop plans to retain high performing provider groups
Continually assess the viability and strengths of the physician network, and identify areas of opportunity, or risk, and work with Network Development on the need to recruit and place appropriate providers into existing practices
Continue ongoing efforts to build a culture of accountability and clinical excellence through strategic coordination and retention of the necessary administrative team, physicians, clinicians, and staff to achieve Revere’s goals and objectives
During the Onboarding hand-off from Network Development, the PNM must have the ability to convey information about Revere Medical to leave newly signed network providers (and staff) with a positive impression about the organization
Has knowledge on all PCPs and Specialists within assigned Chapter, including key information such as group membership, affiliations, recent performance and historically contextual elements
Knowledge of fraud and abuse regulations, health care reimbursement systems, third party payer guidelines, general coding practices

Requirements

• Understanding of the health care delivery setting. Experience with diverse populations a plus.
• Experience working with physician practices; demonstrates an understanding of practice operations
• Strong communication skills; ability to interact with clinical care team and physicians in appropriate manner
• Excellent organizational capabilities and good attention to detail
• Leadership skills, ability to influence, form consensus and drive an agenda
• Ability to present information to small and, at times, large audiences of various skill level
• Bachelor’s degree in relevant field preferred.
• In lieu of a Bachelor’s degree, over eight years of experience will be considered.

Responsibilities

• In collaboration with Revere Medical’s leadership, leverage the clinical volume tracker, risk claims data, Athena referral data and other pertinent data to identify the service lines where the largest area of opportunity (and highest impact) to improve care coordination
• Engage providers, share specific data points and document obstacles / needs in the care coordination tracker
• Present obstacles / needs to the local team and work to address collaboratively then report out to the leadership team on status and if further support is needed
• Review and report out trended performance making sure improvement is being made
• Monitors the availability of in network service gaps that need to be filled to keep patient care services in the Revere Medical system and proactively manages physician and key leadership relationships and brings critical issues leaderships attention
• Collaborate with clinical, quality, and risk adjustment leaders to develop strategies and actions to improve provider group/ network performance as needed
• Advise market leadership and Regional Network Director of providers who are at risk of leaving the network and develop plans to retain high performing provider groups
• Continually assess the viability and strengths of the physician network, and identify areas of opportunity, or risk, and work with Network Development on the need to recruit and place appropriate providers into existing practices
• Continue ongoing efforts to build a culture of accountability and clinical excellence through strategic coordination and retention of the necessary administrative team, physicians, clinicians, and staff to achieve Revere’s goals and objectives
• During the Onboarding hand-off from Network Development, the PNM must have the ability to convey information about Revere Medical to leave newly signed network providers (and staff) with a positive impression about the organization
• Has knowledge on all PCPs and Specialists within assigned Chapter, including key information such as group membership, affiliations, recent performance and historically contextual elements
• Knowledge of fraud and abuse regulations, health care reimbursement systems, third party payer guidelines, general coding practices

Benefits

• Enjoy premium medical coverage with exclusive Revere discounts, a company-funded HSA, plus dental & vision plans to keep you smiling and seeing clearly.
• Boost your future with a 401(k) + company match, and rest easy with company-paid life insurance.
• Need flexibility? Our Vacation Exchange Program has you covered.
• And that’s just the beginning, much more awaits!

What This Job Offers

• Job Type: Full-time
• Career Level: Manager