Senior Network Engagement Representative

2 weeks ago

Broomfield, Colorado, United States SCL Health Full time
Job Summary

As a Senior Network Engagement Representative at SCL Health, you will play a critical role in developing and managing highly aligned member-focused health insurance networks. You will partner with hospital and clinic administrations, Intermountain Medical Group, and affiliated practitioners to demonstrate sound business decisions and develop relationships of trust.

You will coach junior representatives and inform leadership on strategic issues, with a large part of your role involving PPSA contracting with provider groups to bring them over to the Select Health provider network.

Key Responsibilities
  • Establish and maintain strategic business relationships with providers, focusing on member needs, access, and affordability.
  • Act as a strategic partner with provider offices and the organization to build and manage aligned relationships.
  • Provide strategic input and network recommendations for Community Based Care, Specialty Based Care, Multi-specialty clinics, Intermountain Medical Group, or Behavioral Health providers.
  • Research and prepare information to present at the Participating Practitioner Steering Committee (PPSC) regarding providers requesting to join SelectHealth Networks.
  • Participate in PPSC committee to determine provider status on networks.
  • Provide education to physician offices on industry and market trends, SelectHealth strategic direction, and value-based healthcare.
  • Review reports, Dashboards, Provider Insights, and other information relevant to their practices.
  • Use in-depth understanding of fee schedule methodology, Participating Practitioner Service Agreements (PPSA), Medical Staff Services, and other credentialing processes to educate providers and staff.
  • Carefully document provider interactions, issues, concerns, and other pertinent information in appropriate department systems.
  • Lead, organize, and present topics in provider education events.
  • Consistently work with all levels of management to sustain an integrated and aligned relationship with administrators and providers in assigned specialties.
  • May lead or facilitate special projects related to market trends and strategic direction.
  • Use sound judgment to facilitate and recommend changes to internal policies and procedures where necessary.
  • May facilitate resolution of executive-level issues, questions, and problems.
  • Anticipate and recognize issues and be proactive in problem resolution.
  • May oversee the problem-solving process.
  • Work closely with departmental operations, contracting, and compliance teams to develop and manage internal relationships and contracting processes.
  • Work with other organizational departments and teams to coordinate strategic programs, initiatives, and member-centric programs.
  • Provide informal coaching, training, and mentoring to teammates as necessary.
  • PPSA contracting with provider groups to bring them over to the Select Health provider network.
Requirements
  • Bachelor's degree in Healthcare Administration or a business-related field or four years of healthcare experience.
  • Intermediate working knowledge of word processing and spreadsheet programs.
  • Demonstrated history of working independently and executing organizational goals with minimal oversight.
Preferred Qualifications
  • Management-level experience.
  • Ability to think and communicate strategically on various healthcare-related topics.
  • Demonstrated ability to build effective strategic business relationships.
  • Demonstrated ability to make sound business decisions and strategic suggestions.
  • Demonstrated proactive initiative.
  • Excellent communication and presentation skills.
  • Demonstrated effective interpersonal and problem-resolution skills.
  • Clinical or health insurance experience.
  • Demonstrated ability to work well in a team setting.

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