Senior Provider Engagement Professional

CenterWell

11d•Remote

About The Position

Become a part of our caring community and help us put health first The Senior Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Senior Provider Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Provider Engagement Professional represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. NOTE: Work from Home position - the role will require some travel to provider offices, in and around the Peoria to Phoenix areas, but working from Home the majority of the time

Requirements

Bachelor's Degree
5 or more years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience.
Some travel required to provider offices, in and around the Peoria to Phoenix areas, but working from Home the majority of the time.
Working independently is a must.
Self-starter who can work under minimal supervision.
Prior healthcare consulting is a must.
strong, knowledgeable provider engagement professional - Preferably in the managed care space (Medicaid/Medicare)
Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies.
Demonstrated ability to manage multiple projects and meet deadlines

Nice To Haves

Master's Degree
Prefer candidate who work/live in Arizona.
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
Comprehensive knowledge of Medicare policies, processes and procedures

Responsibilities

Travel consisting of Monthly provider visits. Though there may be quarterly travel to Las Vegas for team meetings.
Distribute the Census Management Report (Admits / Discharges) to each practice
Monitoring Issues / Action Items in MSO Connect (membership, payment, contract load)
Email Inbox Management
Follow-up (existing action items)
Outreach management
Research and respond to MSO Member grievance from providers
Facilitate resolution of provider escalations or concerns, coordinating with internal departments as needed.
Evaluate datahub for quality management/ cost and utilization / develop interventions / evaluate provider workflows / Attend team meetings / external Meetings / shared service partner collab meetings, etc.