Value-Based Network Manager

Company Details

Execute EmblemHealth’s value-based physician practice engagement program across all markets to improve quality, health outcomes, access, and experience while managing financial performance. Lead a team that has accountability for oversight and management of specific provider contracts in Provider Network Management. Represent and advances Emblem’s interests in the provider market as the preferred plan through superior customer service, administrative ease, quality, provider/member satisfaction, risk score improvement, cost efficiency, value based contracting and practice transformation activities. Deliver integrated engagement data, tools, and services at point of care, provides training and feedback, and conducts practice assessments; leads performance management for assigned accounts.Assist providers to adopt company platform to close health care gaps and risk documentation and coding. Align and advance relationships with local and regional partners to drive membership growth.

  • Build and sustain collaborative relationships with delegate partners to achieve value-based performance goals through provider – engagement and account management activities.
  • Coordinate 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.
  • Coordinate with delegate to improve the provider experience 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.
  • Drive provider performance and engagement through delivery of routine performance scorecards, reports, and population health data (e.g., attributed membership, physician rosters, medical expense ratio, utilization, quality, and risk coding/documentation).
  • Create strategies to improve key performance indicators; analyze performance data and identify opportunities and performance drivers; coordinate with interdisciplinary teams to improve outcomes (e.g., quality, clinical team, pharmacy, risk adjustment, medical economics, and IT).
  • Conduct practice assessments and collaborates with delegate regarding their physicians and staff to set action plans and goals.
  • 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.
  • Oversee the deployment and education to delegate partner on EmblemHealth self-service population health management and reporting tools, value offerings, and value based and performance programs, complete ad-hoc projects as assigned/required.
  • Train and guide staff in creating impactful relationship with delegated partners
  • Monitor staff projects
  • Work as lead for audits i.e. annual audit, CMS, RADV, Article 44, HEDIA/QARR etc
  • Monitor enrollment reports to identify incorrect risk/non-risk tagging
  • 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 (R)
  • Strong customer service experience with proven ability to build and maintain provider relationships (R)
  • Managed care, value-based payment model, quality, and population health management experience (R)
  • Excellent communication skills (verbal, written, presentation, interpersonal); ability to deliver complex information and achieve positive results (R)
  • Strong problem-solving capabilities (R)
  • Proficient with MS Office applications (Word, Excel, Powerpoint, Outlook) (R)
  • Ability to travel up to 50% to meet with Providers and their representatives (R)

Additional Information

  • Job Type: Standard
  • Schedule: Full-time
  • Employee Status: Regular

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