A highly engaged provider network is critical to ensure members receive the right care at the right place for the right amount of time. The Provider Relations Manager develops and maintains an ongoing collaborative relationship with providers, based on mutual respect, high-quality outcomes, and patient satisfaction. The role works to continually shape the network landscape, by offering objective data and education to all stakeholders in the market. In its highest functional state, it’s the Provider Relations Manager who supports the provider in ensuring recognition by the hospital and plan partners through appropriate rate setting, improved volume and achieving and maintaining PAR/Contracted status. Ultimately the Provider Relations Manager plays a vital role in achieving positive outcomes in the market including but not limited to: SNF LOS, discharges to PAR/contracted providers and closing clinical records.
- Develop relationships with... providers/payers and support the patient-centric model during new implementations.
- Create and maintain a database of pre-implementation provider metrics (e.g. readmission rates, LOS, etc.).
- Coordinate implementation activities (scheduling dates/locations, speakers/attendees, contact points, deck preparation, status updates, etc.).
- Create provider facing educational and summary documents.
- Ensure all necessary logistics are obtained to support a successful implementation (contacts, EMR access, onsite access, etc.).
- Coordinate onsite requirements for naviHealth colleagues (e.g. credentialing, legal requirements, etc.).
- Maintain positive working relationships with providers/payers to build a high quality, highly receptive network base in mature markets.
- Serve as the main point of contact for providers.
- Deliver provider and hospital performance information at a regular cadence.
- Hold providers accountable for professional collaboration (based on collaboration agreement), timely delivery of clinical information, supporting patient and family access to the naviHealth Care Coordinator.
- Evaluate provider receptiveness and quality.
- Lead network issue resolution.
- Proactively identify challenging situations and ensure appropriate action is taken to mitigate escalation.
- Support providers and respond to questions, concerns, and suggestions.
- Solicit feedback as appropriate (focus groups, survey, coalitions).
- Work to resolve provider complaints at local, regional, and national levels
- Develop ongoing support materials for providers.
- Analyze and prepare dashboards for providers.
- Coordinate and deliver dashboard information to providers (SNF and hospital as indicated).
- Provide ongoing education to providers that promote quality service and collaboration.
- Work closely with market presidents and senior clinical managers to monitor and improve hospital DC referral patterns, par and non-par SNF LOS, and closed record statistics.
- Report challenges with care coordinators in the field.
- May participate in network narrowing strategies.
- Work closely with provider relations leadership.
- Analyze data for trends in performance at the market, client, regional, and national levels.
- Support new and existing strategic network initiatives and programs and communicate to providers.
- Support naviHealth brand marketing.
- Support the onboarding of new network colleagues through mentorship.
- Work with internal resources on the development of preferred provider networks.
- Support and implements pay for value programs, as applicable.
- Assist with contracted network development, as assigned.
- Execute direct contracts with post-acute care providers.
- Participate in contract negotiations and contract language review including redlining.
- Manage the contract load process.
- Perform other duties and responsibilities as required, assigned, or requested.
- Bachelor’s degree required
- At least 5 years of experience in a provider-facing or account management role required
- Clinical licensure - Registered Nurse, Physical Therapist, or Occupational Therapist preferred but not required
- Data analytics and reporting experience required
- Experience in managed care, health plan operations in provider contracting, customer service, or provider relations
- Effective negotiation and influencing skills
- Ability to build and foster relationships inside and outside the organization
- Ability to independently plan, organize and prioritize work
- Willingness to work toward team objectives
- Ability to make appropriate organizational determinations in accordance with naviHealth standards of practice independently and timely
- Strong brand promotion and management skills
- Proficiency with Microsoft Office applications
- Experience in Acute and Post-Acute Care Continuum a plus
Work Conditions and Physical Requirements
- Ability to establish a home office workspace
- Ability to manipulate laptop computer (or similar hardware) between office and site settings
- Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard period
- Ability to communicate with clients and team members including use of cellular phone or comparable communication device
- Ability to remain stationary for an extended period (1 - 2 hours)
- Travel requirements
- Up to 75% travel
naviHealth is improving the healthcare experience for seniors to live more fulfilling lives. For nearly a decade, naviHealth has been a trusted partner for the nation’s top health plans, health systems, and at-risk physician groups navigating the shift from volume to value. Powered by a predictive technology and decision support platform that provides clinicians and care teams with evidence-based protocols, naviHealth’s high-touch, proven care model fully supports patients from pre-acute through to the home. With naviHealth, patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions. For more information about naviHealth, visit navihealth.com.
Improving the healthcare experience for seniors to live a more fulfilling life
Rooted in respectGuided by purpose Devoted to service Energized by impact
The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications. naviHealth reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
naviHealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other protected status under applicable laws and will not be discriminated against on the basis of disability