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Provider Network Coordinator

5 months ago

Mineola, Texas, United States Upward Health Full time

Provider Network Coordinator

Upward Health is a home-based medical group specializing in primary medical and behavioral care for individuals with complex needs. We serve patients throughout their communities, and we diagnose, treat, and prescribe anywhere our patients call home. We reduce barriers to care such as long delays due to scheduling. We see patients when they need us, for as much time as they need, bringing care to them. Beyond medical supports, we also assist our patients with challenges that may affect their health, such as food insecurity, social isolation, housing needs, transportation and more. It's no wonder 98% of patients report being fully satisfied with Upward Health

Upward Health provides technology-enabled, integrated, and coordinated care delivery services that improve outcomes and reduce costs for patients with severe behavioral health diagnoses and co-morbid, chronic physical conditions. We are not your typical medical practice. At Upward Health, we see every day as an opportunity to make a difference in our patients' lives. We could tell you about our outcomes and patient satisfaction ratings. We could tell you about our commitment to our mission. Or you could join us and experience it all for yourself.

Why Is This Role Critical?

The Provider Network Coordinator (PNC) plays an integral role in the Upward Health mission by supporting provider and partner network goals through strategy-based initiatives that target and identify external preferred clinical networks to include but not limited to primary care and specialty physicians, hospitals, skilled nursing facilities and ancillary providers such as paramedicine, laboratory, imaging, and pharmacy.

The PNC will establish and maintain ongoing relationships with clinical, tertiary, and ancillary providers to ensure the necessary services and supports are offered to individual patients as part of their whole-health journey through collaboration with external providers. The PNC serves as liaison to external providers translating the needs and concerns of our patients into collaborative action plans that support annual wellness visits, increasing quality metric capture, reducing hospital readmissions, and supporting care transition plans and overall coordination of care activities. Our ideal PNC lives within the community our patients reside and have a deep understanding of the various clinical supports that are available to our patients.

The PNC establishes and maintains ongoing relationships based upon a set of company values and principles, including safety and trust, integrity, quality service and dedication to ensuring patient outcomes by consulting with and supporting external clinical providers in the collective effort to serve our patients.

Key Responsibilities for Provider Network Coordinator:

  • Identify key organizations, institutions and influencers across core clinical service domain needs to build a comprehensive local external preferred clinical network of primary care and specialty providers, hospitals, skilled nursing facilities and ancillary providers such as paramedicine, laboratory, imaging, and pharmacy networks that can serve Upward Health patients and their unique needs.
  • Create, maintain, and update the clinical market resource directory in Salesforce as resources are added and/or discontinued. Prioritize network and directory building through both an internal and external data-driven approach to focus on the resources most prevalent to our patients and local market. Ensure all identified resources meet 5-star standard. Directory to include external primary and specialty providers, imaging, laboratory, SNFs, homecare, paramedicine, and pharmacy.
  • The PNC will identify and develop relationships with paramedicine providers to support 24/7/365 triage support. The PNC will identify mobile laboratories and mobile imaging providers (x-ray/US) and free-standing imaging/lab preferred partners with extended evening and weekend hours.
  • Utilizing data analytics and patient specific report cards, target high volume PCP practices to increase/schedule AWV and comprehensive risk assessments, address open quality metric gaps in care, and reduce avoidable hospital admissions. The PNC with support of other UH resources will provide key data points such as quality gaps, HCC/diagnoses capture opportunities, ADT alerts, etc.
  • Utilize hospital inpatient admission alerts as an enrollment opportunity. Support Outreach Specialists in the enrollment process through contact with key hospital stakeholders (floor nurse, discharge planners, etc.) and ensure patients that do not consent to enrollment have a post discharge visit with external PCP. The PNC will ensure external PCP has a scheduled visit with patient within 7 days post discharge and will further seek enrollment efforts by collaborating with the PCP.
  • The PNC will work with hospital discharge planners, social workers etc., to ensure coordinated care transitions after an ED or IP visit has occurred.
  • Serve as the primary point of contact for external clinical network partners that serve in the capacity of clinical service providers to our patients and develop strong meaningful relationships with key stakeholders. Facilitate check-ins (both in virtual and in person-as needed) with Upward Health providers and partners to ensure needs and expectations are met to the highest standards.
  • Support a unified network of clinical and community partners that shares information for patient care coordination as part of the patient's needs plans.
  • Field-based responsibilities include to act as a representative of the community in which our patients reside. Participate in relative clinical/community events/meetings that are hosted by hospitals, providers, etc.
  • Other duties as assigned in support of goals and objectives.

Key Competencies for Community Network Coordinator:

  • Interpersonal savvy, demonstrated by the ability to interact with and influence others.
  • Experience coordinating across teams and external partners to meet individual patient or clinical member needs.
  • Experience in provider relations, hospital relations, community relations.
  • Ability to engage with individuals representing different cultures and backgrounds, adapting language and style as needed.
  • Excellent written, computer, and oral communication skills - will proactively and thoroughly communicate with other members of the team.
  • Active listening skills, quick thinking, and able to both be compassionate and respond to objections.
  • Strong organizational and presentation skills
  • Excellent coordination of multiple schedules and constantly changing demands from various stakeholders

Minimum Requirements for Community Network Coordinator:

  • Must live/reside in the patient service area.
  • Valid driver's license and access to a vehicle with current and active insurance
  • Deep experience working in and/or with providers and hospitals
  • Able to work flexible hours, including occasional night/weekend work.
  • Bachelor's degree preferred.
  • Ability to travel within patient and clinical service area.
  • Strong communicator, verbal and written, with a deep ability to build trusting relationships.

Upward Health is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.



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