Provider Relations Manager - Inland Empire Health Plan

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!

 

Join us as a Provider Services Representatives at IEHP, where you’ll be the linchpin in cultivating and maintain robust relationships with our Providers. Be at the forefront of organizational polices, delivering trainings, and driving network improvement plans. Act as a provider Advocate, resolving issues and championing IEHP’s quality metrics and service goals. Dive into Provider visit, strategically focusing on high-volume providers to align with our quality initiatives. Lead investigations, support through utilization reports, and promote electronic submission capabilities for HEDIS metrics. Collaborate with various departments, attend meetings, and be a vital part of Provider relations.

 

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:

PROVIDER ENGAGEMENT (RELATIONSHIP / QUALITY / OPERATIONS / STRATEGIC INITIATIVES)
1. Provide in-person New Primary Care Location (PCL) in-service on a timely basis.
2. Partner with the provider to provide PCL, establish Meaningful Engagement cadence and PCL-specific content.
3. On a monthly basis, provide in-person or as requested, Meaningful Engagements to established PCLs; no less than 10/year.
4. Provide in-person or as requested New Provider in-service for UCs and OBGYNs; establish Meaningful Engagement cadence.
5. On a quarterly or as requested basis, provide in-person or telephonic Meaningful Engagements to non-PCLs.
6. Provide Strategic Engagements with PCLs as requested by other IEHP Departments, including but not limited to Quality, Health Education, Health Services, and Strategy.
7. Maintain accurate and timely log of Provider visits in compliance with NCQA standards, and DHCS and CMS regulatory requirements.

PROVIDER NETWORK DEVELOPMENT
8. Recruit new PCLs into IEHP-Direct.
9. Add IEHP-Direct Link to existing PCPs/PCLs.
10. Identify potential new specialty/vision/behavioral health service Providers.

PROVIDER CONTRACTING
11. Take lead in all contracting activity and communications for new PCLs.
12. Provide support to the Contracting Department and maintain on-going Provider communication with new UCs, OBGYNs, and other specialists as requested.
13. Coordinate with Contracts Department to address Provider inquiries concerning rate/service changes and claims disputes.

PROVIDER CREDENTIALING SUPPORT
14. Take lead in obtaining all credentialing collateral as required for new PCLs and their Physician Extenders (PE)
15. Provide credentialing department support and on-going Provider communication with new UCs, OBGs, and other Specialists as requested.
16. Provide credentialing department support and on-going Provider communication with existing Specialists during recredentialing process as requested.

PROVIDER ON-BOARDING & ACTIVATION
17. Manage New PCL On-Boarding Checklist activities.
18. Assist in managing New Specialist On-Boarding Checklist activities.

PROVIDER MARKETING & MEMBERSHIP GROWTH
19. Perform Membership Growth Assessment for PCLs as requested or directed; identify opportunities for growth.
20. Coordinate development of PCL-specific Membership Growth Plan.
21. Partner with PCL and IEHP Marketing & Sales Team to implement the Membership Growth Plan. 

ETHICAL AND PROFESSIONAL CONDUCT
22. Promote the highest standards of ethical and professional conduct to Team Members through demonstrated individual performance.

PROGRAMS, POLICIES AND PROCEDURES AND DATABASES AND SYSTEMS
23. Stay current on all aspects of the IEHP programs, policies, and procedures as they relate to the Providers of IEHP, including IEHP lines of business and Member benefits. Proficiency in utilization of all Provider Services databases and systems.

Qualifications:

Education & Requirements 

• Three (3) or more experience with customer service
• One (1) year of experience including Hospital, Managed Care, Medical Group, IPA, and HMO
• Experience with managed care
• Bachelor's degree from an accredited institution required
• The PRM is an external-facing, field-based position that requires PRMs devote 80% of their time providing monthly (or as needed) meaningful field engagements with their assigned PCLs and quarterly (or as needed) engagements with their assigned non-PCLs
• Data entry involving computer keyboard and screens, automobile travel within the IEHP service area, distribution of reports and supplies to outside provider offices

 

Key Qualifications

• Must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points
• Working knowledge of Medical Group IPA and HMO operations
• The PRM should demonstrate a strong sense of ownership of IEHP’s relationship with the Provider that recognizes the Provider as a valuable partner
• Ability to proactively engage with the Provider and staff to determine root cause and address business issues (such as administrative, regulatory and customer service matters)
• Ability to train and educate Providers and Provider staff as needed, which may include counseling providers diplomatically, while retaining a positive working relationship
• Ability to independently troubleshoot and problem-solve issues as they arise, making an assessment when escalation to a Senior Provider Relations Manager, Supervisor, or another IEHP department as needed and initiating, coordinating, and participating in problem-solving meetings between the Provider and IEHP stakeholders, including senior leadership and Providers.  Take initiative in preventing and resolving issues between the Provider and IEHP whenever possible
• Independently deliver training and presentations to assigned Providers and their staff, answering questions that come up on behalf of IEHP. May also deliver training and presentations to larger groups, such as leaders and management of Provider offices
• Ability to perform as an integral role in network development, by monitoring and enforcing company policies and procedures, while increasing Provider effectiveness by educating and promoting participation in various IEHP initiatives. Examples of such initiatives include administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, IEHP Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.)

 

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location:

On-Site

Pay Range:USD $34.41 - USD $44.73 /Hr.