Provider Performance Specialist Senior
Priority Health
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Benefits offered by this job
Job summary
Priority Health is seeking a Senior Specialist, Provider Network Management to build and maintain strategic relationships with our most complex provider partners. You will act as a trusted advisor, lead resolution of operational challenges, and support quality and provider incentive programs.
You will mentor team members, serve as an Epic Super User, and contribute to provider engagement across departments to improve outcomes and efficiency.
Qualifications
- Bachelor's degree in health care administration, business administration, accounting, finance, clinical or health and human services or equivalent education and experience.
- 5 years of relevant experience in provider network management or health care insurance.
- 2 years of relevant experience directly interacting in a clinical environment.
Responsibilities
- Own and manage relationships with Priority Health's largest, most complex provider partners.
- Lead Joint Operating Committees (JOCs) and operational forums.
- Resolve complex provider operational issues involving multiple stakeholders.
- Support performance improvement and provider incentive programs; interpret and communicate program results.
- Function as an Epic Super User and identify opportunities to improve efficiency and provider experience.
- Mentor and develop team members; share best practices across the Provider Network Management team.
Skills
Education
Tools
Job description
The Senior Specialist, Provider Network Management is responsible for building and maintaining strategic relationships with Priority Health's most complex provider partners. This role serves as a trusted advisor to providers and internal stakeholders, leading the resolution of complex operational challenges while supporting quality and provider incentive programs.
The Senior Specialist demonstrates advanced healthcare industry knowledge, strong business acumen, and the ability to influence outcomes across departments. This individual serves as a mentor to team members, an Epic Super User, and a key contributor to provider engagement.
- Serve as the primary relationship owner for Priority Health's largest, most complex provider partners.
- Build trusted partnerships with executive and operational leaders.
- Lead Joint Operating Committees (JOCs) and operational forums.
- Anticipate provider needs, identify emerging risks, and proactively develop solutions.
- Lead the resolution of complex provider operational issues involving multiple internal and external stakeholders.
- Navigate ambiguity while maintaining productive relationships.
- Facilitate cross-functional problem-solving.
- Escalate and manage issues appropriately to ensure timely resolution.
- Serve as a subject matter expert for provider incentive programs.
- Partner with providers to support performance improvement efforts and program understanding.
- Interpret and communicate quality and incentive program results, opportunities, and operational impacts.
- Support implementation of strategic initiatives that improve provider and member outcomes.
- Function as an Epic Super User.
- Identify opportunities to improve operational efficiency and provider experience.
- Provide recommendations to reduce provider abrasion.
- Onboard and mentor new team members.
- Share best practices and operational knowledge across the Provider Network Management team.
- Provide guidance and informal leadership on complex provider issues and escalations.
- Serve as a resource and coach for Specialists and newer team members.
- Bachelor's Degree in health care administration, business administration, accounting, finance, clinical or health and human services or equivalent education and experience
- 5 years of relevant experience of either provider network management experience, health care insurance or other health care delivery setting
- 2 years of relevant experience directly interacting in a clinical environment
- Provider or Payer experience.
- Experience with provider incentive programs.
- Experience facilitating executive-level meetings.
- Experience managing complex provider relationships and operational challenges.
- Demonstrated ability to lead meetings, presentations, and stakeholder discussions.
- Strong analytical and problem-solving skills.
- Familiar with Microsoft Excel skills, including V Lookups and Pivot Tables
- Excellent written and verbal communication skills.
- Ability to influence without direct authority.
- Experience with Quality programs.
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Provider Network Management - PH Managed Benefits
Full time
Day (United States of America)
40
8 a.m. to 5 p.m.
Monday to Friday
N/A
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
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