HSCSN Sr Mgr Provider Relation

Health Services for Children with Special Needs•Washington, WA

13h

About The Position

Essential job duties: Manage and improve network management operations to achieve or exceed performance standards/budgets. Lead the development and execution of provider network business plans, strategies and goals. Provide leadership and guidance to the Provider Relations, including hiring, developing, training, and retaining high-quality, productive employees. Serve as a resource for Health Plan expansion strategies beyond the Washington, DC market. Serve as a Provider Advocate within HSCSN. Manage the provider portal. Serves as single-point-of-contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract. reimbursement, practice and network profitability, ACOs and other HCP initiatives, as applicable. Responds timely (within one business day) to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly through to resolution. Is proactive in identifying issues and determining root cause so that they can be resolved timely and completely. Escalates certain issues as appropriate to leadership. Build collaborative relationships with physicians and their office staff. Represent HSCSN at community and other provider meetings. Serve as point of contact for all Department of Healthcare Finance communications and initiatives. Other job duties: May perform other duties in addition to those outlined in this job description. Organizational Accountabilities Organizational Accountabilities (Managers) Leadership Excellence Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved Innovates through improvement of care and/or efficiency of operational processes. Dedicated to a standard of performance excellence and high quality Collaboration Creates a safe environment that encourages brainstorming, creativity and “out-of-the-box” thinking Encourages a diverse group of people to communicate effectively and embrace creative thinking Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way Demonstrates listening and feedback skills Leadership Skills Proactively assumes responsibility and accountability for results to include management of organizational change Empowers staff in ensuring a culture of transparency, fairness, respect and excellence Strategically aligns operational and tactical objectives to drive business results. Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication. Supervisory Responsibilities The incumbent will be responsible for the general direction of staff member(s). Blood Borne Pathogen Exposure Category II\: Job may expose incumbent occasionally or in emergency situations to blood, body fluids, non-intact skin or tissue specimens. Protected Health Information Access Level Level IV - Full Access Incumbents in this job may access any protected health information associated to a customer's needs, the service(s) rendered and the position's functions. Working Environment This job operates in an office environment. Physical Requirements Sedentary Work\: Lifting 10 lbs. maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met. Travel Requirements Travel to Provider sites may be warranted. The incumbent should have a valid driver’s license or access to a motor vehicle.

Requirements

High School Diploma or GED General Studies (Required)
5 years related experience in managed care and/or care management. (Required)
5 years progressive supervisory experience. (Required)
5 years Prior experience in a health plan, managed care organization, medical group physician office or IPA setting (Required)
Understanding of Medicaid benefits.
Excellent verbal and written communication skills.
Familiarity with computer systems and applications.
Computer literate in Microsoft suite
Strong organizational skills.
Ability to interpret and apply departmental requirements.
Ability to make sound decisions and use good judgment.
Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service.
Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practice.
The incumbent should have a valid driver’s license or access to a motor vehicle.

Nice To Haves

Bachelor's Degree Business, Health Care Management, Health Care Administration (Preferred)

Responsibilities

Manage and improve network management operations to achieve or exceed performance standards/budgets.
Lead the development and execution of provider network business plans, strategies and goals.
Provide leadership and guidance to the Provider Relations, including hiring, developing, training, and retaining high-quality, productive employees.
Serve as a resource for Health Plan expansion strategies beyond the Washington, DC market.
Serve as a Provider Advocate within HSCSN.
Manage the provider portal.
Serves as single-point-of-contact to the physician network and is an accountable owner, responsive to physician needs.
Knowledgeable about incentive programs, contract. reimbursement, practice and network profitability, ACOs and other HCP initiatives, as applicable.
Responds timely (within one business day) to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly through to resolution.
Is proactive in identifying issues and determining root cause so that they can be resolved timely and completely.
Escalates certain issues as appropriate to leadership.
Build collaborative relationships with physicians and their office staff.
Represent HSCSN at community and other provider meetings.
Serve as point of contact for all Department of Healthcare Finance communications and initiatives.
May perform other duties in addition to those outlined in this job description.
The incumbent will be responsible for the general direction of staff member(s).