Provider Relations Manager

Inland Empire Health Plan•Rancho Cucamonga, CA

1d•$71,573 - $93,038•Hybrid

About The Position

The IEHP Provider Relations Manager (PRM) is responsible for network development, network adequacy and provider training and education, in alignment with IEHP’s overall mission, core values, and strategic plan and in compliance with all relevant federal, State and local regulations. More specifically, the PRM creates, develops and maintains strong relationships with IEHP-Direct Providers (IEHP Direct providers are those who contract directly with IEHP as opposed to contracting with an IEHP delegated intermediary Provider organization) including but not limited to Primary Care Locations (“PCLs” which include Primary Care Physicians (PCPs) and mid-level practitioners (Physician Assistants (PAs) and Nurse Practitioners (NPs), OB/GYNs, Urgent Care Centers (“UCs”), and other providers as assigned, including IPA-affiliated providers for initial onboarding. In this role, the PRM will serve as the IEHP Subject Matter Expert (“SME”) on the providers assigned to them and will act as a “Success Liaison” for their Providers. The PRM serves as the primary point of communication with the Provider and maintains oversight of the relationship from inception of the Provider’s relationship with IEHP onwards. In addition, the PRM will be responsible for recruiting new PCPs into IEHP-Direct as well as identifying opportunities to develop the Specialty/Vision/Behavioral Health networks as needed 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 experience with customer service
One (1) year of experience including Hospital, Managed Care, Medical Group, IPA, and HMO
Experience with managed care
Bachelor's degree from an accredited institution required
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
Working knowledge of Medical Group IPA and HMO operations
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
The PRM should demonstrate a strong sense of ownership of IEHP’s relationship with the Provider that recognizes the Provider as a valuable partner
Ability to proactively engage with the Provider and staff to determine root cause and address business issues (such as administrative, regulatory and customer service matters)
Ability to train and educate Providers and Provider staff as needed, which may include counseling providers diplomatically, while retaining a positive working relationship
Ability to independently troubleshoot and problem-solve issues as they arise, making an assessment when escalation to a Senior Provider Relations Manager, Supervisor, 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.
Ability to perform as an integral role in network development, by monitoring and enforcing company policies and procedures, while increasing Provider effectiveness by educating and promoting participation in various IEHP initiatives. 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.)
Data entry involving computer keyboard and screens, automobile travel within the IEHP service area, distribution of reports and supplies to outside provider offices.

Responsibilities

Provide in-person New Primary Care Location (PCL) in-service on a timely basis.
Partner with the provider to provide PCL, establish Meaningful Engagement cadence and PCL-specific content.
On a monthly basis, provide in-person or as requested, Meaningful Engagements to established PCLs; no less than 10/year.
Provide in-person or as requested New Provider in-service for UCs and OBGYNs; establish Meaningful Engagement cadence.
On a quarterly or as requested basis, provide in-person or telephonic Meaningful Engagements to non-PCLs.
Provide Strategic Engagements with PCLs as requested by other IEHP Departments, including but not limited to Quality, Health Education, Health Services, and Strategy.
Maintain accurate and timely log of Provider visits in compliance with NCQA standards, and DHCS and CMS regulatory requirements.
Recruit new PCLs into IEHP-Direct.
Add IEHP-Direct Link to existing PCPs/PCLs.
Identify potential new specialty/vision/behavioral health service Providers.
Take lead in all contracting activity and communications for new PCLs.
Provide support to the Contracting Department and maintain on-going Provider communication with new UCs, OBGYNs, and other specialists as requested.
Coordinate with Contracts Department to address Provider inquiries concerning rate/service changes and claims disputes.
Take lead in obtaining all credentialing collateral as required for new PCLs and their Physician Extenders (PE)
Provide credentialing department support and on-going Provider communication with new UCs, OBGs, and other Specialists as requested.
Provide credentialing department support and on-going Provider communication with existing Specialists during re-credentialing process as requested.
Manage New PCL On-Boarding Checklist activities.
Assist in managing New Specialist On-Boarding Checklist activities.
Perform Membership Growth Assessment for PCLs as requested or directed; identify opportunities for growth.
Coordinate development of PCL-specific Membership Growth Plan.
Partner with PCL and IEHP Marketing & Sales Team to implement the Membership Growth Plan.
Promote the highest standards of ethical and professional conduct to Team Members through demonstrated individual performance.
Stay current on all aspects of the IEHP programs, policies, and procedures as they relate to the Providers of IEHP, including IEHP lines of business and Member benefits. Proficiency in utilization of all Provider Services databases and systems.