Manager, Network Relations

📁
Manager & Professional
💼
ConnectiCare
Sign Up for Job Alerts
  • The Manager, Network Relations will lead a team dedicated to establishing superior relationships with key provider stakeholders as a competitive differentiator.  The individuals in this team will serve as the single point of contact ensuring a holistic B2B experience.  Furthermore, the position is charged with developing and deploying strategies to educate all providers and their agents about ConnectiCare’s policies and procedures and capabilities, with a focus on increasing operational efficiency.  
  • This role is also responsible for managing the day to day operations of the Network Relations Account Management team and providing tactical support when needed. The Manager, Network Relations will also be responsible for developing and deploying provider general and targeted communication strategies, market messaging, and ensuring the efficient disposition of escalated issues. 

Responsibilities:

  • Manages the Network Relations Account Manager team.  Provides leadership to the team to ensure holistic deployment of the overarching Network Strategy. Develops and trains staff to execute tactically.
  • Drives corrective actions at the organizational level regarding germane issues presented by network providers.  
  • Has accountability for budget development and execution for the department. 
  • Engages directly with key providers only as needed to ensure superior B2B relationships relative to all competitors.
  • Ensures that the team delivers positive business relationships with Tier 1 providers.  Provides support on an as needed basis for Tier II providers in alignment with departmental objectives. 
  • Develops strategies and content for educating providers on products, programs and policies, ensuring clarity and compliance while supporting enterprise business objectives.  
  • Ensures compliance with all regulatory requirements related to provider networks, particularly as it relates to directory representation.
  • Works with matrix partners to develop tools and capabilities to drive efficiencies regarding Provider interaction with the ConnectiCare. 
  • Develops transition plan and manages expansion of the team post transformation.  Develops future state business process and resources to ensure successful transition and management of retained work.
  • Develops strategies and manages all aspects of Provider Network engagement including but not limited to accurate provider data sets, ecommerce adoption, network communications, quality improvement and coding accuracy.
  • Owns all aspects of provider network policy and procedure communications and publication. 
  • Assists the contracting team in development and execution of new payment models and contracting standards.  Identifies any contract provisions resulting in ineffective claims administration or alternative payment/population health arrangements.Identifies provider issues resulting in inefficient inquiries and develops improvement plans to drive operational efficiency through better alternatives including but not limited to web portal options. Develops overall strategies to minimize transactional friction with the provider community.
  • Identifies provider issues resulting in inefficient inquiries and develops improvement plans to drive operational efficiency through better alternatives including but not limited to web portal options. Develops overall strategies to minimize transactional friction with the provider community.
  • Manage tactical communications with Provider Community in partnership with other functional areas.
  • Provides leadership to identify issues and drive resolution with matrix partners in the areas of Operations, Population Health, Medical Operations, Sales, Compliance, Quality, Risk Adjustment and others as needed.
  • Act as a liaison for ConnectiCare for site visits with regulatory bodies such as CMS, CT DOI and NCQA related to how CCI works with providers to ensure compliance and engagement with ConnectiCare programs.
  • Performs other duties and special projects as assigned.

Requirements:

  • Bachelor's Degree or equivalent combination of education and experience in the healthcare field 
  • Preferred 3+ years of previous experience in a health care provider relations capacity, managed care environment preferred
  • Understanding of industry standards including but not limited to claims payment, reimbursement methodologies, population health strategies, quality improvement strategies, risk adjustment and health plan/provider B2B transactional interactions 
  • Presentation and teaching skills required
  • Excellent oral/written communication abilities coupled with superior interpersonal skills required
  • Demonstrated analytic abilities
  • Initiative and leadership abilities
  • Must be able to analyze contracts and describe their intent to providers
  • Must be able to understand insurance products and describe them to providers
  • Ability to manage conflict to productive outcomes which preserve organizational objectives

Previous Job Searches

Similar Listings

EmblemHealth

Farmington, Connecticut

📁 Manager & Professional

EmblemHealth

Farmington, Connecticut

📁 Manager & Professional

EmblemHealth

Farmington, Connecticut

📁 Manager & Professional