Manager, Provider Relations

Description:

This is a hybrid role that requires regular travel to provider sites and occasional onsite team meetings.

The Manager, Provider Relations Government Programs is responsible for designing, developing, and implementing provider engagement strategies for D-SNP programs (One Care / Senior Care Options) within their respective service areas with a focus on ancillary and community-based providers (LTSS, CBO, etc.). This role ensures that provider engagement strategies align with Mass General Brigham Health Plans mission and company goals. This individual is responsible for overseeing the departments day-to-day operations and the direct management, development, and growth of the Ancillary Provider Network Account Executives assigned to support government programs.

Principal Duties and Responsibilities:

Leadership, Development, & Operations Management
Responsible for managing the day-to-day operations of the Provider Relations team focused on the ancillary and community-based providers that support these government programs.
Coach and develop Provider Network Account Executives to maximize their abilities, develop core competencies, and ensure understanding of team mission and goals.
Consistently embrace change, act as a forward thinker, and model a positive outlook.
Consistently promote a culture of change and growth by promoting alliance in individual, departmental, divisional, and company goals.
Delegate appropriately and function as an effective coach.
Challenge and effectively lead the team toward achieving its goals. Provide support and coaching to meet goals.
Work with Director, Provider Relations to establish and maintain strategic direction within service area and lines of business that is consistent with department, division and corporate goals and initiatives.
Responsible for performance management of direct reports including but not limited to appraisals, goals setting, training and development, and corrective action if necessary.
Provide ongoing training and support to Provider Network Account Executives on provider needs, member needs, and cultural competencies.

Provider Management & Engagement
Support the Director in the development of provider network engagement strategies for the D-SNP and associated government lines of business.
Apply in-depth knowledge of organizational and program-specific goals to lead the Provider Relations team through the execution of Mass General Brigham Health Plans provider network strategy.
Serve as a subject matter expert for government lines of business including a nuanced understanding of rules and organizational needs for all relevant provider types, with a specific focus on ancillary and community-based providers (LTSS, CBO, etc.).
Provide cross-functional support to Provider Contracting by maintaining an understanding of marketplace trends and provider needs.
Provide oversight of and maintain accountability for the delivery of relevant provider manuals and other important content to the network.
Maintain effective working relationships with the provider community within the identified region.
Manage differences and conflicts and achieve effective outcomes and resolution to complex provider issues.
Anticipate and prepare provider territory for changes in the healthcare market.
Understand and communicate, as appropriate, community-related issues, which affect provider-Mass General Brigham Health Plan relationships.
Work collaboratively to ensure network messaging is reflective of provider expectations and experience.
Ensure provider engagement and outreach strategies are deployed within regional territories.
When required, present educational and training materials to large provider audiences (100+).
Support the Director with the redistribution of territory assignments and stabilizing associate support structures for providers.
Work with Provider Network Account Executives to proactively engage providers and identify educational opportunities that decrease administrative burden and ensure provider compliance to contract terms.
Ensure Provider Network Account Executives are routinely meeting with key constituents to ensure smooth payer/ provider interactions.
Ensure the team is applying appropriate timeframes in response to provider inquiries and escalations.
Work with Provider Network Account Executives to establish and maintain operations management practices with large healthcare delivery systems and providers under complex contractual agreements.
When necessary, attend and represent Mass General Brigham Health Plan at provider network events and functions.

Interdepartmental & Company Support
Provide consultative support to various initiatives and workgroups by sharing provider perspective, risk analysis, and analytic problem-solving.
Represent Provider Relations and, when necessary, Provider Network Management on internal workgroups and initiatives.
Maintain awareness of network compliance requirements for government lines of business and develop plans to ensure provider alignment with compliance requirements.
Participate in provider contracting and network development, product initiatives, and regulatory compliance activities as needed/required.
Assist with the monitoring of executed provider contracts ensuring network access meets adequacy requirements across each line of business.
Represent Provider Network Management on cross-functional initiatives with Enterprise Data teams to ensure provider data is routinely updated.
Collaborate cross-functionally to support provider operations including in the areas of Provider Network, Provider Enrollment and Credentialing
Provide support and assistance to the departments responsible for the maintenance of websites, portals, directories, and manuals as it relates to provider information.
Support cross-functional teams in obtaining crucial or required information from Providers including but not limited to HEDIS, Credentialing, Grievance and Appeals, SIU, etc.
Manage corporate interdependencies to ensure timely and accurate resolution of complex and sensitive provider issues.
Set performance standards and norms of high-quality service from internal departments.
Foster an atmosphere of collaborative teamwork and diversity within the department, division and the company.
Act as a conduit of competitor and market information affecting local providers and share with internal stakeholders.
Resolve high-profile escalations requiring cross-collaboration with senior leadership, medical directors, compliance and downstream departments.
Support organizational effectiveness by fostering a culture that recognizes inter-departmental dependencies.
Support company affordability goals by influencing strategy implementation and managing provider expectations.
Collaborate with other departments and team to create administrative simplifications.

Qualifications:

Bachelors degree required or the equivalent combination of training and experience (masters degree, preferred).
Atr least 5-10 years of relevant experience including the management of provider relationships with ancillary, community-based provider relationships and providers of Long-term Services and Supports (LTSS).
Experience working across government lines of business, preferred.
Nuanced understanding of both the Federal (CMS) and State (Massachusetts EOHHS) regulatory environment, including One Care and Senior Care Options programs, preferred.
5 years management experience, preferred.
Proven ability to foster and manage deep relationships with key personnel at large system providers.
Proven leadership, decision-making and consensus and relationship building skills

About Us:

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the worlds leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided with reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

Primary Location MA-Somerville-MGB Health Plan at Assembly Row

Work Locations MGB Health Plan at Assembly Row 399 Revolution Drive Somerville 02145

Job Professional/Managerial

Organization Mass General Brigham Health Plan

Schedule Full-time

Standard Hours 40

Shift Day Job

Employee Regular

Job Posting Nov 22, 2024