Community Health Center Relationship Manager/ Ombudsman

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 85,000 - 125,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking a Community Health Center Relationship Manager/Ombudsman to oversee the organization’s CHC network relationships in Rhode Island. You will cultivate, manage, and strengthen CHC leadership interactions, advocate for CHC needs, and coordinate resolutions with internal partners to ensure a positive CHC experience.

The role requires 5+ years in managed care or CHC environments, excellent communication, and the ability to travel as needed.

Qualifications

• Bachelor’s degree in Health Administration, Business Administration, Public Health, or equivalent.
• 5+ years in managed care, healthcare orgs, provider relations, or Federally Qualified Health Centers.
• Knowledge of Medicaid/Medicare reimbursement methodologies, provider billing, contracts, and regulations.
• Strong analytical, problem-solving, project management, and organizational skills.
• Excellent written, verbal, presentation, facilitation, customer service, and relationship management.
• Proficiency in Microsoft Office; Cognos and Salesforce experience preferred.

Responsibilities

• Serve as single point of contact for CHC leadership on Neighborhood operations.
• Interface with Neighborhood leadership to provide updates and feedback on CHC concerns.
• Build relationships with CHC executives and identify ways Neighborhood can support their mission.
• Triages issues and ensures needs are addressed in a timely manner.
• Lead CHC internal/external meetings and coordinate with internal and delegated partners.
• Identify patterns and develop solutions; contribute to policy/process improvements.
• Represent the organization at RI CHC events and initiatives; travel as needed.

Skills

Analytical skills

Problem-solving

Project management

Relationship management

Communication

Organizational skills

Education

Bachelor’s degree in Health Administration, Business Administration, Public Health, or equivalent

Tools

Microsoft Office

Cognos

Salesforce

Job description

Position Overview:The Community Health Center Relationship Manager/Ombudsman is responsible for the end-to-end oversight of the organization’s relationships with Rhode Island’s network of Community Health Centers (CHC). In this highly visible position, the CHC relationship manager/ombudsman acts as a liaison between the organization and its CHCs by cultivating, managing and strengthening relationships with CHC leadership, while bringing issues to fair and expeditious resolution. This position ensures that organizational resources are obtained for addressing issues efficiently and effectively while exploring and recommending options for improvements/enhancements. Is responsible for anticipating issues or needs and advocating as necessary to ensure a positive CHC experience with Neighborhood.Duties and Responsibilities:Responsibilities include but are not limited to the following:Serve as single point of contact for CHC leadership on all matters related to Neighborhood operations.Interface directly with Neighborhood leadership to provide formal/informal updates and share feedback related to CHC concerns.Regular interaction with CHC executives to proactively build relationships and identify ways in which Neighborhood can continue to support their mission.Accountable for ensuring the interests of the CHC’s are understood, promoted and addressed across the organization. Responsible for triaging issues and ensuring needs get addressed timely.Key supporter of Neighborhood’s efforts to fulfill CHC needs related to member care, outreach and promotion.Lead departmental, inter-departmental and external efforts to ensure a satisfied CHC provider network by reducing administrative burdens and resolving complex problems.Develop and maintain strong professional relationships with CHC leadership, staff and providers, functioning as a liaison to research and resolve issues and strategic objectives.Establish regular contact with and visits to CHCs, including but not limited to operations meetings, staff education, provider training and/or other eventsIdentify patterns of organizational and systematic issues, and work to develop solutionsParticipate in the development of organizational policies, procedures and processes related to, or impacting, the CHC network.Lead CHC internal and external meetings to support awareness, priorities and issue resolution.Coordinate escalated issues with appropriate partners both internally and with delegated entities.Keep management informed of critical CHC issues.Identify and execute opportunities for training and education with the CHCs.Represent the organization at meetings, events and/or other initiatives, as appropriate and necessary, including but not limited to the Rhode Island Health Center Association (RIHCA) and CHC specific eventsSupport the core functions of the department and assist with departmental objectives and projects, as applicable.Other duties as assignedQualificationsRequired:Bachelor’s degree in Health Administration, Business Administration, Public Health, or equivalent HMO/Community Health Center relationship experience (5+ years experience) in lieu of degreeThree (3) + years’ experience in working in managed care, healthcare organizations, provider relations, and working with Federally Qualified Health CentersKnowledge of commercial, Medicaid, and Medicare reimbursement methodologies, provider billing practices, claims operations, contract terms, and federal/state healthcare regulationsStrong analytical, problem-solving, project management, and organizational skills, with the ability to manage multiple priorities and data across various platformsExcellent written, verbal, presentation, facilitation, customer service, and relationship management skills, with the ability to engage stakeholders at all levelsDemonstrated ability to work independently and collaboratively across departments to achieve organizational goals and drive continuous process improvementIntermediate to advanced proficiency in Microsoft Office Suite (Word, Excel, Outlook)Ability to travel with reliable transportation; valid driver's license and proof of insurance required when using a personal vehiclePreferred:Experience with project managementExperience with Quality Improvement Processes (e.g. Lean, Six Sigma)Experience in an Accountable Care Organization (ACO)Experience in CognosExperience with SalesforceNeighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.