Provider Relations Account Manager

CareSource Management Services; Massachusetts; On-site; USD 72,000 - 116,000; Full time

Job summary

CareSource/Commonwealth Care Alliance is seeking a Provider Relations Account Manager to influence internal stakeholder relationships and engage with providers to build, manage, and maintain strong relationships with a focus on operational efficiencies and proactive engagement to reduce burden and retain providers.

The role involves owning provider relationships, leading escalations, preparing meetings, educating partners on updates, analyzing processes, and ensuring compliance with contracts

Qualifications

• Excellent written and verbal communications skills.
• Strong interpersonal skills and high level of professionalism.
• Effective listening and critical thinking skills.
• Ability to work independently and within a team.

Responsibilities

• Own the relationship with Health Partner/Provider with a proactive focus on overall provider satisfaction and retention.
• Identify, solution, and execute on escalations and systemic opportunities for continuous operational improvement.
• Prepare and lead internal and external meetings with key stakeholders.
• Educate health partners/providers on operational updates.
• Analyze current work processes, identify gaps and implement corrections.
• Perform provider outreach, field visits and site evaluations to ensure compliance with provider contracts and regulations.

Skills

Communication skills

Interpersonal skills

Leadership

Project management

Analytical skills

Problem-solving

Education

Bachelor's degree in Business Administration, or related field

Equivalent years of relevant work experience

Tools

Microsoft Office

Job description

Job Summary:

The Provider Relations Account Manager at CareSource/Commonwealth Care Alliance is responsible for working in a highly matrixed organization and influencing internal stakeholder relationships. This role will engage with providers to build, manage and maintain relationships, with a strong focus on operational efficiencies, proactive engagement, and reduced burden which all leads to retention of provider relationships.

Essential Functions:

• Own the relationship with the Health Partner/Provider with a proactive focus on overall provider satisfaction and retention
• Identify, solution, and execute on Health Partner/Provider escalations and systemic opportunities (including complex and/or non-routine) for continuous operational improvement
• Prepare and lead internal and external meetings with key stakeholders
• Assure department deliverables are met with timely follow up
• Educate health partners/providers on, all operational updates
• Analyze current work processes, identify gaps and implement appropriate correction
• Responsible for maintaining strong internal relationships with key business partners
• Perform provider outreach, field visits and site evaluations to ensure compliance with the provider contract, and state and federal requirements
• Utilize and leverage key operational dashboards with providers
• Manage multiple projects, collect and analyze data and disseminate to appropriate departments as necessary
• Ensure appropriate documentation of interactions and projects
• Support Leadership in meeting annual goals
• Performs any other job related duties as requested.

Education and Experience:

• Bachelor's degree in Business Administration, or related field preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Three (3) years of experience in the health plan/managed care industry required
• Experience in a managed care organization preferred

Competencies, Knowledge and Skills:

• Proficient with Microsoft Office to include Word, Excel and PowerPoint
• Excellent written and verbal communications skills
• Ability to develop, prioritize and accomplish goals
• Detail oriented
• Strong interpersonal skills and high level of professionalism
• Effective listening and critical thinking skills
• Effective problem-solving skills with attention to detail
• Ability to work independently and within a team
• Strong negotiation skills
• Excellent leadership skills
• Exceptional emotional intelligence
• Ability to create and maintain excellent working relationships
• Project management
• Conflict resolution
• Facilitation management
• Analytical skills

Licensure and Certification:

• Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential.
• Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
• Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need
• May be required to travel greater than 50% of time to perform work duties.
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members
• Over 50% (Mobile) Routine travel required

Compensation Range:

$72,200.00 - $115,500.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied t