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,…