The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
We are currently hiring a Provider Relations Manager to join our team!
Must reside in California - remote position.
What You Will Be Doing:
Under general direction, the Provider Relations Manager is responsible for developing and fostering collaborative relationships between the provider community and managing department resources and operations in a manner that supports network development, growth and retention. Work is varied and moderately complex, and requires a moderate degree of discretion and independent judgment.
Our Vision:
Continuously improve the health of our community.
Our Mission:
We provide healthcare value and advance wellness through community partnerships.
Essential Functions:
- Develops department objectives, action plans and budgets that align with company-wide and department objectives; monitors progress and implements appropriate interventions based on results.
- Develops and maintain direct strong working relationships with provider partners.
- Manages a team of provider services representatives, providing coaching, mentoring and professional development opportunities.
- Monitors team’s productivity against performance goals or metrics and other requirements to ensure job expectations are met.
- Ensures that all provider services representatives have been properly trained and have all the necessary tools to make them effective while engaging with provider partners.
- Plans and assigns work; makes timely and effective adjustments as required.
- Monitors and reviews regulatory guidance that impacts providers and delegates; oversees the development and timely and accurate implementation of all regulatory requirements.
- Monitor and ensure that all provider partners are met with on a regular cadence, which will be based on various factors.
- Responsible for conducting ride-along visits with provider services representatives, or other health plan teams, to provide support and monitor effectiveness of visits and relationships.
- Prepare and present material and facilitate provider forums, trainings and seminars.
- Researches and resolves the most complex and/or sensitive provider issues.
- Anticipates the need for and oversees the development, production and distribution of provider communications; ensures that internal provider-related documentation is accurate.
- Develops and implements provider education programs to ensure understanding of HPSJ services, programs, administrative practices, and requirements.
- Identifies, monitors, and analyzes appropriate metrics and reports, including provider administrative practices and provider surveys; develops timely and effective internal and external corrective action plans; oversees progress and completion.?
- Identifies and communicates contracting opportunities.
- Prepares for and oversees regulatory audits; develops and implements corrective action plans based on analysis.
- Compiles, develops, and submits or oversees the compilation, development, and submission of internal and external reports; ensures accuracy and timeliness.?
- Implements and oversees maintenance of business processes and workflows that increase effectiveness and efficiency
- Develops, implements, and maintains policies; ensures effective implementation of procedures and guidelines.
- Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission, and values.
- Hires, supervises, and retains, and ensures that line staff hire supervise and retain competent staff.
What You Bring:
Knowledge, Skills, Abilities and Competencies
- In-depth knowledge of general medical policy benefits and exclusions.
- Strong knowledge of managed care regulatory guidelines.
- Knowledge of Medi-Cal and/or Medicare programs.
- Basic knowledge of the principles and practices of managed care.
- In-depth knowledge of claims billing, procedure and diagnosis coding and medical terminology.
- In-depth knowledge of provider contract components and language.
- In-depth knowledge of the business, economic, demographic, and political trends and developments affecting healthcare and managed care in general, and provider network development and operations in particular.
- Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions.?
- Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.?
- Very strong assessment and analytical skills, including the ability to synthesize, distill concepts, draw conclusions, and identify implications.
- Decision quality: Makes good and timely decisions that keep the organization moving forward.?
- Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies.?
- Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.?
- Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organizational goals.?
- Ensures accountability: Holds self and others accountable to meet commitments.?
- Drives results: Consistently achieves results, even under tough circumstances.?
- Persuades: Uses compelling arguments to gain the support and commitment of others.?
- Collaborates: Builds partnerships and works collaboratively with others to meet shared objectives.?
- Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.?
- Being resilient: Rebounds from setbacks and adversity when facing difficult situations.?
- Strong knowledge of and ability to identify, implement, monitor, and analyze relevant enrollment, claims and utilization of data metrics models as they relate to provider relations, and implement effective interventions based on results.
- Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of HPSJ.?
- Strong oral and written communication skills with the ability to communicate professionally, effectively, and persuasively to diverse individuals and groups inside and outside of HPSJ; includes the ability to effectively explain complex information.
- Strong presentation skills, including the ability to tailor presentations to a specific audience, and address and interact with large groups.
- Strong collaboration skills, with demonstrated ability to create and foster a collaborative work environment, maintain effective, high-performance teams, and organize people and resources to solve problems and identify opportunities.
- Strong customer service skills.
- Ability to create relevant department objectives, and create, execute, and monitor business plans.
- Demonstrated ability to develop and manage realistic budgets.
- Strong project management skills and demonstrated ability to lead complex initiatives.?
- Intermediate skills in Windows, Word, Excel, PowerPoint, and Outlook.?
- Demonstrated ability to articulate and support HPSJ’s vision, mission, values, and strategy, integrate into management practices, and foster their manifestation among staff.?
- Demonstrated ability to supervise staff in a manner that maximizes employee performance and business results.?
- Ability to handle confidential information with appropriate discretion.?
- Ability to speak and be understood in English.?
What You Have:
Education and Experience
Required
- Bachelor’s Degree; and
- At least four years progressively responsible experience in provider relations or similar; and
- At least two years in a managed care environment; and
- At least three years supervisory experience; or
- Equivalent combination of education and experience.
Preferred
- Experience working with Medi-Cal and/or Medicare providers and populations
- Knowledge of the economic or healthcare issues, or issues affecting the underserved in San Joaquin County and/or surrounding areas.
Licenses, Certifications
Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.
What You Will Get:
HPSJ Perks:
- Competitive salary
- Robust and affordable health/dental/vision with choices in providers
- Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
- CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
- Two flexible spending accounts (FSAs)
- Employer-Paid Term Life and AD&D Insurance
- Employer-Paid Disability Insurance
- Employer-Paid Life Assistance Program
- Health Advocacy
- Supplemental medical, legal, identity theft protection
- Access to exclusive discount mall
- Education and training reimbursement in addition to employer-paid elective learning courses.
- A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
- A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
- Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.
Equal employment opportunity, including veterans and individuals with disabilities.
