Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
Provider Relationship Manager
Summary of Job
Accountable for oversight and management of specific provider contracts in Provider Network Management. Lead day to day operations for all activities related to contracts, contract optimization, implementation of new programs and business ownership of all EPMO and IT projects associated with contracts. Foster strong relationships across EmblemHealth to advance the strategic goals of the organization. Provide regular check-ins with providers and their offices to ensure needs are met. Manage follow-up on outstanding issues and communicate back to provider/offices and EmblemHealth leadership. Exercise good judgement to determine appropriate escalation of issues, anticipating provider needs. Advise leadership teams on emerging trends and issues. Partner with leadership to ensure organizational excellence. Advise/implement departmental policies and protocols to enhance efficiency and effectiveness of workflows.
Responsibilities
• Lead meetings with key subject matter experts (e.g., quality, risk adjustment, pharmacy and medical management) 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, in coordination with providers and with the plan through focused education and training, performance reporting, effective communication of new products, benefits, policies or initiatives, and resolution of provider issues across the business as the primary contact for the account.
• Manage relationships between Providers and Plan.
• Identify and recommend system enhancements and process improvements resulting in savings and associated efficiencies.
• Drive provider performance and engagement through delivery of routine performance scorecards, reports, and population health data (e.g., attributed membership, physician rosters, and utilization).
• Responsible for updating trend reporting/dashboards/issue trackers.
• Create strategies to improve key performance indicators; analyze performance data and identify opportunities and performance drivers.
• Act as primary subject matter expert for each contract.
• Work cross organizationally to ensure successful implementation of provider performance programs and agreements.
• Assure provider contractual relationships and obligations are maintained in compliance with regulatory requirements and EmblemHealth policies and procedures.
• Conduct annual contract reviews and amendments for assigned accounts as required to maintain current and accurate
measures and benchmarks and targets in accordance with NYSDOH, CMS, NCQA, and other regulatory bodies.
• May train and guide staff in creating impactful relationship with provider partners.
• Monitor projects to ensure timely delivery to leadership.
• Work as lead for audits i.e. annual audit, CMS, RADV, Article 44, HEDIA/QARR etc.
Qualifications
• Bachelor’s Degree in a health services, healthcare administration, business administration or related field (Required)
• 5 – 8+ years’ experience in healthcare, plan or provider operations/administration/relations or related area (Required)
• Strong customer service experience with proven ability to build and maintain provider relationships (Required)
• Managed care, value-based payment model, quality, and population health management experience (Required)
• Excellent communication skills (verbal, written, presentation, interpersonal); ability to deliver complex information and achieve positive results (Required)
• Strong problem-solving capabilities (Required)
• Proficient with MS Office applications - Word, Excel, Powerpoint, Outlook (Required)
• Ability to travel up to 50% to meet with Providers and their representatives (Required)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
EmblemHealth may provide work visa sponsorship depending on factors such as business unit requirements, position nature, costs, and applicable laws and regulations.