Provider Relations Manager Health Plans II - Health Plan Network

Summary:

Works to ensure the contracted provider network is educated and oriented into the CHRISTUS Health Plan with operational understanding and expectations. Works in collaboration with additional operations teams to ensure the network provider has the education needed to function at the highest level with CHRISTUS Health Plan, including but not limited to, Quality, Pharmacy, and Care Management. This position is responsible for onboarding, educating, and servicing the provider contracted network. Serves as lead relationship contact for contracted providers. Plays an integral part in ensuring the contracted providers have a good network experience.

Responsibilities:

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.

Educate all newly contracted providers with the CHRISTUS Health Plan process.

Serve as primary contact for network providers when they have an issue needing resolution.

Develop and maintain collaborative provider relationships that facilitate provider engagement, integration, and path to value arrangements.

Manage provider engagement/risk continuum, prospecting potential providers for value-based opportunities.

Apply network configuration and incentive - based payment models as appropriate to improve quality and efficiency.

Leverage financial and utilization data with physicians and healthcare executives to provide actionable goals and opportunities to reduce expenses for providers with a shared savings opportunity.

Facilitate clinical education, leveraging clinical experience from your internal partners.

Partner with internal stakeholders to create a seamless experience for providers.

There will be travel requirement 85%.

Organize and prioritize work to meet deadlines.

Must have good judgment, initiative, and problem-solving abilities.

Handle and resolve complex issues with little assistance.

Able to perform multiple tasks simultaneously and with strong attention to detail.

Requirements:

Education/Skills

Bachelor’s degree preferred.

Proficient in Microsoft Word, PowerPoint, and Excel.

Excellent written and verbal skills.

Experience

5 years’ Experience in healthcare field provider-facing.

Prior experience working with Medicare and Commercial Payers.

Healthcare Claim Knowledge.

Presentation/Training experience.

Experience with ACO, Risk-Based, Value-Based Contracting highly preferred.

Licenses, Registrations, or Certifications

Driver’s License required.

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time