Senior Provider Relations Manager

Overview

What you can expect! 

 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

 

The Senior Provider Relations Manager (Senior PRM) will independently lead efforts to develop and maintain strong and consistent relationships with IEHP Providers which include IEHP-Direct Providers (IEHP Direct Providers are those who contract directly with IEHP as opposed to contracting with an IEHP delegated intermediary Provider organization) including but not limited to Primary Care Locations (“PCLs” which include Primary Care Physicians (PCPs) and mid-level practitioners (Physician Assistants (PAs) and Nurse Practitioners (NPs)), Independent Practice who contract directly with IEHP as opposed to contracting with an IEHP delegated intermediary Provider organization) including but not limited to Primary Care Locations (“PCLs” which include Primary Care Physicians (PCPs) and mid-level practitioners (Physician Assistants (PAs) and Nurse Practitioners (NPs)), Independent Practice Associations (IPAs) OB/GYNs, Urgent Care Centers (“UCs”), and other Providers as assigned. 

Additionally, this position will guide Team Members within Provider Relations and from other IEHP stakeholder departments in network development, network adequacy and Provider training and education efforts in alignment with IEHP’s overall mission, core values, and strategic plan and in compliance with all relevant federal, State and local regulations.  

Under the general supervision of the Provider Relations Managers, the Senior PRM Is responsible for mitigating Provider issues and help project implementation to improve the quality of care provided to IEHP Members. The Senior PRM will also serve as a Subject Matter Expert for external department workgroups and activities that involve Provider Relations and serve as a model of leadership for the team.

 

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits

Perks

 

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more. 

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off- vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities

Key Responsibilities

Assist in the supervision of all aspect of the day-to-day operations of the PRM department needs ensuring daily metrics are met.

Maintain and build on relationships with large SafetyNet groups such as (RUHS, ARMC, SACH). Conduct maintenance in-services for established Providers on incentive Programs as requested by groups or PRM Leadership.

Stay current on all aspects of the PRM operation role, including all IEHP lines of business, Member benefits and IEHP Programs.

Act as a lead trainer for New PRMs during “on the floor PRM training” including MOCK in-services and shadowing New PRMs in the field overseeing performed in-services.

Provide recommendations towards the development and enhancement of the Provider Relations Manager job aids and training material.

Provide recommendations for the development of external and internal Polices & Procedures as requested.

 Ensure department coverage and lead Team Members through complicated concerns.

 Handle more complex escalated Providers, including research into complex operational issues and timely follow-up with the Providers to ensure customer service standards are met and resolution occurs.

Troubleshoot problems as they arise and make an assessment when escalated to a Senior Provider Relations Manager.

Monitor and assure internal monthly audit prep alongside the QA Team Member (IPA PET, IPA web verification, New PCP) occurs before PRM Management reviews.

Promote the highest standards of ethical and professional conduct to Team Members through demonstrated individual performance.

 Analyze Provider Relations Manager statistics and propose updates to processes and policies and necessary to the Provider Relations Manager. Ensure departmental m