Strategic Provider Relations & Performance Manager

EmblemHealth; New York (NY); On-site; USD 78,000 - 149,000; Full time

Job summary

EmblemHealth is seeking an experienced provider contracts leader to oversee contract management, optimization, and implementation of new programs within Provider Network Management. You will own contracts, anticipate provider needs, and report on performance trends.

You will lead cross-functional teams, drive process improvements, and ensure regulatory compliance across NYSDOH, CMS, and NCQA standards. Strong communication and travel up to 50% are required.

Qualifications

• Bachelor's degree in health services, healthcare administration, business administration or related field.
• 5-8+ years' experience in healthcare, plan or provider operations/administration/relations or related area.
• Strong customer service experience with provider relationships.
• Managed care, value-based payment model, quality, and population health management experience.
• Excellent communication skills (verbal, written, presentation, interpersonal).
• Strong problem-solving capabilities.
• Proficient with MS Office applications - Word, Excel, PowerPoint, Outlook.
• Ability to travel up to 50% to meet with Providers and their representatives.

Responsibilities

• Lead meetings with key subject matter experts and delegate to implement new workflows, reporting requirements, regulatory changes, and new products.
• Lead joint quarterly and monthly meetings to review progress and performance opportunities with leadership.
• Improve the provider experience through education, training, performance reporting, and clear communication of policies or initiatives.
• Manage relationships between Providers and Plan.
• Identify and implement system enhancements and process improvements resulting in savings and efficiencies.
• Drive provider performance and engagement through routine scorecards and population health data.
• Update trend reporting and dashboards for leadership review.
• Create strategies to improve KPIs and analyze performance data.
• Act as primary subject matter expert for each contract.
• Collaborate across teams to implement provider performance programs and agreements.
• Ensure compliance with regulatory requirements and EmblemHealth policies.
• Conduct annual contract reviews and amendments per NYSDOH, CMS, NCQA guidelines.
• May train staff in building strong provider partnerships.
• Monitor projects to ensure timely delivery to leadership.
• Lead audits (CMS, RADV, Article 44, HEDIA/QARR, etc.).

Skills

Customer service

Managed care experience

Communication skills

Problem solving

MS Office

Travel up to 50%

Education

Bachelor's degree in health services, healthcare administration, business administration or related field

Job description

EmblemHealth is seeking an experienced provider contracts leader to oversee contract management, optimization, and implementation of new programs within Provider Network Management. You will own contracts, anticipate provider needs, and report on performance trends.

You will lead cross-functional teams, drive process improvements, and ensure regulatory compliance across NYSDOH, CMS, and NCQA standards. Strong communication and travel up to 50% are required.