PCP Provider Relationship Manager – Network Physician Engagement
Thanks for your interest in the PCP Provider Relationship Manager – Network Physician Engagement position.
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OPERATIONS:
Develop and implement processes within the SWHR primary care practices that directly drive results related to SWHR initiatives for both revenue and expense. Track and communicate provider performance through distribution of reports and dashboards; identify underperforming physician and escalate through appropriate channels; work closely with assigned SWHR Medical Directors to deliver appropriate messaging to providers. Thoroughly understand various SWHR and payer performance incentive programs and communicate regularly to providers the methodology, their current and anticipated results, and answer questions/concerns as appropriate. Adhere to department policies and procedural manuals as well as be responsible for leaning and enforcing new guidelines as they are developed. Meet established performance/productivity standards set by supervisor; maintain clear communication with supervisor to ensure transparency and minimal operational disruptions.
ONBOARDING:
On-board community physicians onto contracts, processes, technology platforms, resources and tools after they are recruited into SWHR. Conduct educational workshops and orientations as necessary for participating providers and staff on a regular basis to enhance their understanding of contracted managed care products, SWHR or payer policies and procedure, SWHR technology platforms, performance incentive programs, clinical guidelines and best practices.
COMPLIANCE:
Ensure assigned community providers are current on SWHR membership dues and coordinate with SWHR Finance to notify provider on dues and follow up as necessary to drive collections.
Gather, review, and verify all pertinent information related to MCOs; ensure that any updated, changes, etc. that would impact network physicians and staff are disseminated to appropriate personnel in a timely manner. Track and report on activities as required by management in a time and organized manner.
Qualifications
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High school diploma or equivalent (required)
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High School Diploma or Equivalent and 4 years' additional Experience in lieu of Bachelor's Degree (required) AND
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6 Years’ Experience in Health Care, Managed Care, or Practice Management without Bachelor's Degree (required)
OR
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Bachelor's Degree Healthcare, Business, Science, Marketing, Communication (required)
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2 Years’ Experience in Health Care, Managed Care, or Practice Management with Bachelor's Degree (required)
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Master's Degree Healthcare, Business, Science, Marketing, Communication (preferred)
AND
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Experience in Provider Relations and Managed Care (strongly preferred)
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Valid Texas Drivers’ License, current auto insurance, and reliable automobile transportation Upon Hire (required)
Position Responsibilities SWHR PCP Provider Relationship Manager performs:
RELATIONSHIP BUILDING:
Lead recurring provider engagement through various channels including pod meetings, special education sessions, and other group or individual interactions. Establish and maintain relationships with assigned physicians through office visits, telephone calls, prompt resolution of issues, and overall excellent customer service. Share practice performance results with PCP and Office Manager on a regular basis and make recommendations for actions that will drive positive results. Maintain high service levels with primary care provider practices and be responsible for keeping "finger on the pulse" of the primary care provider network related to opportunities for improvement with SWHR. Acts as primary contact for provider practices to resolve issues between provider and Managed Care Organizations (MCOs). Own issues raised by provider practices related to SWHR throughout the issue lifecycle-from identification, monitoring through resolution, by coordinating with appropriate SWHR stakeholders. Identify and execute on opportunities for enhancing provider experience, performance or for streamlining internal operations to increase productivity and effectiveness. Own provider data in Customer Relationship Management Platform (CRM) for assigned practices and ensure integrity and completeness of all provider data including demographic information, NPIs, TINs, managed care information, enrollment dates, SWHR internal assignments, technology platform information, and others as directed by supervisor. Build internal processes to foster close working relationship with other SWHR departments and partners to drive success. Participate in provider events organized by SWHR as requested and perform required duties. Conduct surveys and various ad-hoc campaigns across SWHR primary care provider network as necessary.
Lead recurring provider engagement through various channels including pod meetings, special education sessions, and other group or individual interactions. Establish and maintain relationships with assigned physicians through office visits, telephone calls, prompt resolution of issues, and overall excellent customer service. Share practice performance results with PCP and Office Manager on a regular basis and make recommendations for actions that will drive positive results. Maintain high service levels with primary care provider practices and be responsible for keeping "finger on the pulse" of the primary care provider network related to opportunities for improvement with SWHR. Acts as primary contact for provider practices to resolve issues between provider and Managed Care Organizations (MCOs). Own issues raised by provider practices related to SWHR throughout the issue lifecycle-from identification, monitoring through resolution, by coordinating with appropriate SWHR stakeholders. Identify and execute on opportunities for enhancing provider experience, performance or for streamlining internal operations to increase productivity and effectiveness. Own provider data in Customer Relationship Management Platform (CRM) for assigned practices and ensure integrity and completeness of all provider data including demographic information, NPIs, TINs, managed care information, enrollment dates, SWHR internal assignments, technology platform information, and others as directed by supervisor. Build internal processes to foster close working relationship with other SWHR departments and partners to drive success. Participate in provider events organized by SWHR as requested and perform required duties. Conduct surveys and various ad-hoc campaigns across SWHR primary care provider network as necessary.
OPERATIONS:
Develop and implement processes within the SWHR primary care practices that directly drive results related to SWHR initiatives for both revenue and expense. Track and communicate provider performance through distribution of reports and dashboards; identify underperforming physician and escalate through appropriate channels; work closely with assigned SWHR Medical Directors to deliver appropriate messaging to providers. Thoroughly understand various SWHR and payer performance incentive programs and communicate regularly to providers the methodology, their current and anticipated results, and answer questions/concerns as appropriate. Adhere to department policies and procedural manuals as well as be responsible for leaning and enforcing new guidelines as they are developed. Meet established performance/productivity standards set by supervisor; maintain clear communication with supervisor to ensure transparency and minimal operational disruptions.
ONBOARDING:
On-board community physicians onto contracts, processes, technology platforms, resources and tools after they are recruited into SWHR. Conduct educational workshops and orientations as necessary for participating providers and staff on a regular basis to enhance their understanding of contracted managed care products, SWHR or payer policies and procedure, SWHR technology platforms, performance incentive programs, clinical guidelines and best practices.
COMPLIANCE:
Ensure assigned community providers are current on SWHR membership dues and coordinate with SWHR Finance to notify provider on dues and follow up as necessary to drive collections.
Gather, review, and verify all pertinent information related to MCOs; ensure that any updated, changes, etc. that would impact network physicians and staff are disseminated to appropriate personnel in a timely manner. Track and report on activities as required by management in a time and organized manner.
In addition to the required qualifications, a successful PCP Provider Relationship Manager will:
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Must be highly organized and detail oriented
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Must have discretion, good judgment, personal motivation and the ability to work independently
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Excellent oral, written and interpersonal communication skills
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Excellent problem solving and troubleshooting skills with the ability to exercise mature judgment
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Proficiency working with Microsoft Word, Excel and PowerPoint; experience in Salesforce is a plus
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Must be able to problem solve, make decisions, interpret data, organize and analyze workflows, write, plan, use math formulas, and simple arithmetic.
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Ability to run reports, perform analysis and summarize results
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Ability to interpret and present complex analytical information and effectively communicate results
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Ability to create customized action plans to drive results.
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Ability to manage multiple task assignments
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Ability to establish priorities, solve problems and deal with a variety of variables in situations where only limited standardization exists.
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Ability to identify trends and escalate issues where the root cause is not isolated to one error
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Flexible schedule and availability to attend business meetings during early mornings and evenings outside of normal 8 am to 5 pm business hours
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Ability to exhibit confidence when working directly with physicians and their staff
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Demonstrate a general knowledge of healthcare delivery systems; knowledge of risk adjustment, quality, utilization and care management is a plus
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Comfortable with working in a dynamic environment and meeting high performance expectations
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Must be able to uphold confidentiality requirements of the organization
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Must be dependable, self-motivated, and exhibit initiative
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Must be able to operate general office equipment including but not limited to computer, phones, and related media and information devices
Why Southwestern Health Resources
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
Moving healthcare forward
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
We invite you to learn more about us at www.southwesternhealth.org.
Let’s move healthcare forward – together.
Highlights:
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Combining the strengths of UT Southwestern Medical Center, Texas Health Resources and more than 2,500 community physicians, we offer the largest provider network in North Texas. SWHR covers approximately 700,000 patient members across 16 counties in North Texas.
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SWHR is the parent organization of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.
Additional perks of being a SWHR PCP Provider Relationship Manager
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Gain a sense of accomplishment by contributing in a teamwork environment
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Positively impact patients’ quality of life
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Receive excellent mentorship, comprehensive training and dedicated clinical leadership resources
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Enjoy opportunities for growth
Explore Southwestern Health Resources Careers for more information and to search all career opportunities.
Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org.