Senior Provider Relations Manager

Inland Empire Health Plan•Rancho Cucamonga, CA

23h•$80,059 - $106,059•Onsite

About The Position

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! The Senior Provider Relations Manager (Senior PRM) will independently lead efforts to develop and maintain strong and consistent relationships with IEHP Providers which include 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)), Independent Practice 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)), Independent Practice Associations (IPAs) OB/GYNs, Urgent Care Centers (“UCs”), and other Providers as assigned. Additionally, this position will guide Team Members within Provider Relations and from other IEHP stakeholder departments in network development, network adequacy and Provider training and education efforts in alignment with IEHP’s overall mission, core values, and strategic plan and in compliance with all relevant federal, State and local regulations. Under the general supervision of the Provider Relations Managers, the Senior PRM Is responsible for mitigating Provider issues and help project implementation to improve the quality of care provided to IEHP Members. The Senior PRM will also serve as a Subject Matter Expert for external department workgroups and activities that involve Provider Relations and serve as a model of leadership for the team. 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. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more. CalPERS retirement 457(b) option with a contribution match Generous paid time off- vacation, holidays, sick State of the art fitness center on-site Medical Insurance with Dental and Vision Paid life insurance for employees with additional options Short-term, and long-term disability options Pet care insurance Flexible Spending Account – Health Care/Childcare Wellness programs that promote a healthy work-life balance Career advancement opportunities and professional development Competitive salary with annual merit increase Team bonus opportunities

Requirements

Two (2) years of experience in an IEHP Provider Relations Manager role
Proven successfully meeting monthly required in-services with a variety of Specialty Providers.
Exceeds on major Provider Relations Manager functions and goals set by department leadership in latest annual review
Bachelor’s degree from an accredited institution required
Proficient in MediTrac (HSP), NDDB, DataOps, Creating Standard Work and Job Aids, Microsoft Excel.
Exceptional leadership, problem solving and critical thinking skills.
Strong presentation and written communication skills.
Ability to present new training material to a group of Team Members.
Skilled in maintain strong collaborative relationships across multiple departments and IPAs.
Advanced knowledge of Medical Group, IPA, and HMO Operations.
Strong attention to detail.
Ability to work independently, under pressure and work within deadlines.
Ability to gather and analyze data in detailed and highly organized manner.
Ability to establish and maintain effective working relationships, trustworthy, reliable and an independent worker.
The Senior 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 high visibility Providers, provider’s their staffs (including senior leaders and physicians) and PRMs to determine root cause and to address business issues (such as administrative.
Regulatory and customer service matters).
Ability to assume a leadership role in increasing provider effectiveness by educating and promoting Provider 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.).

Responsibilities

Assist in the supervision of all aspect of the day-to-day operations of the PRM department needs ensuring daily metrics are met.
Maintain and build on relationships with large SafetyNet groups such as (RUHS, ARMC, SACH).
Conduct maintenance in-services for established Providers on incentive Programs as requested by groups or PRM Leadership.
Stay current on all aspects of the PRM operation role, including all IEHP lines of business, Member benefits and IEHP Programs.
Act as a lead trainer for New PRMs during “on the floor PRM training” including MOCK in-services and shadowing New PRMs in the field overseeing performed in-services.
Provide recommendations towards the development and enhancement of the Provider Relations Manager job aids and training material.
Provide recommendations for the development of external and internal Polices & Procedures as requested.
Ensure department coverage and lead Team Members through complicated concerns.
Handle more complex escalated Providers, including research into complex operational issues and timely follow-up with the Providers to ensure customer service standards are met and resolution occurs.
Troubleshoot problems as they arise and make an assessment when escalated to a Senior Provider Relations Manager.
Monitor and assure internal monthly audit prep alongside the QA Team Member (IPA PET, IPA web verification, New PCP) occurs before PRM Management reviews.
Promote the highest standards of ethical and professional conduct to Team Members through demonstrated individual performance.
Analyze Provider Relations Manager statistics and propose updates to processes and policies and necessary to the Provider Relations Manager.
Ensure departmental management reports are accurate, valid, and timely.
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.
Serve as a Subject Matter Expert as assigned by the Provider Relations Managers when interdepartmental projects require representation from Provider Relations.
Aid the Manager, Provider Relations in determining weekly and monthly schedule, as needed to meet, or exceed the Plan's monthly site visit goals.
Provide guidance and support to Provider Relations Managers in their develop of implementation of PCL Membership Growth Plans.