Network Relations Consultant

CareMore Health Management Services, LLC; Los Angeles (CA); On-site; USD 81,000 - 121,000; Full time

Benefits offered by this job

Bonus eligible

Job summary

CareMore Health Management Services, LLC is seeking a Network Relations Consultant to own performance engagement with MDs, develop strong provider relationships, and resolve complex issues. The role emphasizes on-site visits, communication of policy changes, and education to providers.

Responsibilities include contract coordination, training delivery, and monitoring provider utilization patterns to support quality care delivery and satisfaction.

Qualifications

• Bachelor's degree required.
• Minimum of 3 years customer service experience including 2 years as a Network Management Rep.
• Willingness to travel to worksite and other locations as necessary.

Responsibilities

• Owns individual performance engagement for assigned MDs and maintains provider relationships through on-site visits.
• Communicates administrative and programmatic changes and educates providers.
• Resolves complex provider issues and handles appeals for prompt resolution.
• Coordinates non‑negotiated contracts for new and existing providers as needed and researches contract disputes.
• Supports provider training and education on care management policies and billing/reimbursement practices.

Skills

Customer service

Provider relations

Relationship management

On-site visits

Education

Bachelor's degree

Job description

Job Description Summary

The Network Relations Consult is responsible for assigned network PCP performance including PAHAF completion, AWV and Star rating of 4 or above.

How will you make an impact & Requirements

Network Management Consultant: will own individual performance engagement and on-the-ground relationship development for new and existing MDs. Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues. Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution. May be responsible for coordinating non-negotiated contracts for new and existing providers as needed. Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices. May participation in Joint Operation Committees (JOC) of larger provider groups. Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. Conducts seminars to support the understanding of managed care policies and procedures. Identifies network access and deficiencies and develops recruitment and contracting strategies. Coordinates and conducts provider training including developing and distributing provider relations materials. Responsible for providing quality, accessible and comprehensive service to the company's provider community. Provide assistance regarding education, contract questions and non-routine claim issues. Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department. Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery. Tracks and conduct provider refresher training. Researches issues that may impact future provider negotiations or jeopardize network retention.

Requirements

Requires a Bachelor's degree Minimum of 3 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background. Travels to worksite and other locations as necessary.

Quality and AWV

• Consistent PCP visits focused on:
  • PAHAF completion, STARS gaps closed
  • HCC Re-capture rate
  • PCP referrals
• Provider Education:
  • Model of Care
  • Portal usage/training
• Referrals and authorizations:
  • New PCP on-boarding
• Issue Resolution:
  • Issue identification & resolution:
    • Claims
    • Referrals and authorizations
    • G&A

Compensation

The posted compensation range represents the national market average. Compensation for roles located in premium or high-cost geographic markets may fall above this range. This position is bonus eligible based on individual and company performance.

Compensation Range: $80,819.00 to $121,228.00 The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

About Mosaic Health

Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. Learn More about Mosaic Health Learn More about Millennium Physician Group Learn More about CareMore Health Learn More about Castlight Health Learn More about Vera Whole Health