Provider Relations Representative

1 week ago

Arcadia, United States Clever Care Health Plan Full time

Wage Range: $24.00/hr - $28.00/hr Job Summary This position serves as an integral member of the Provider Relations and Contracting Team and reports to the Senior Manager of Community & Provider Development. This role assists and supports day-to-day contracting, network development and provider relations activities including managing key action items and relationships, special project initiatives, and deadlines. Functions & Job Responsibilities * Manage provider relationships in assigned territories or assign areas with all types of providers, including physicians, IPAs, hospitals, ancillary services, acupuncture and other Eastern Wellness providers and health care professionals. * Provide information on Clever Care activities applicable to a particular office. * Work with internal departments as well as providers to obtain required information to facilitate Clever Care activities, including annual wellness visits (AWV), special needs plan (SNP) attestations, audit follow-up, etc. * Participate in Clever Care sales and marketing events, joint operating meetings (JOM) and other public facing activities. * Identify potential contracting opportunities amongst all types of bilingual providers; work with the Senior Manager of Community & Provider Development on the actual contracting and negotiation process, including fee-for-service (FFS) and capitation reimbursement strategies. * Identify new partnership opportunities with network providers. * Discuss co-branding to offer a wider reach to focused populations. * Develop provider affiliation announcement letters for member awareness. * Coordinate and set up health fairs and other special events. * Manage key provider relationships by being the main point of contact for providers and business staff. * Maintain existing provider partnerships - acupuncture, primary care physicians, and other alternative networks. * Contribute to the development and management of alternative network initiatives (e.g., herbal vendors). * Support Sales and Marketing Teams on the needs of independent brokers, agencies, and field marketing organizations (FMOs). * Establish relationships with community-based organizations such as Places of Worship, Community Health Centers, and Social Services. * Maintain effective channels of communication with all internal departments, the most frequent being Operations, Credentialing, Compliance, Sales and Marketing, and Member Services. (#LI-Hybrid) (See LinkedIn) #LI-Onsite Qualifications Required Qualifications Education/Experience: * 1-2 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations Skills: * Demonstrated ability to manage multiple projects and meet deadlines. * Strong communication and presentation skills with ability to effectively communicate with all levels of the organization, internally and externally. * Must be passionate about contributing to an organization focused on continuously improving consumer experiences. Preferred Qualifications Education/Experience: * Bachelor's Degree Skill: * Ability to speak, read and write on a business level in one of the following languages: Khmer, Thai, Mandarin, Cantonese, Korean or Vietnamese. Also Spanish. Physical & Working Environment. Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation: * Must be able to travel when needed or required * Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking) * Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business. Significant driving to provider offices and company-sponsored events. Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate's state residency.

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