It’s Time For A Change Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018 . Are we recognized? Definitely. We have been named one of Becker’s 150 Great Places to Work in Healthcare in 2016, 2017, 2018 and 2019, and One of the 50 Great Places to Work in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
New Century Health merged with Evolent Health in 2018 and continues to lead transformative change in specialty care management as an Evolent company. Within the Evolent ecosystem of provider-centric solutions for value-based care, our New Century Health team focuses on cost and quality improvement for oncology and cardiology specialty care. With more than 15 years of proven results, New Century Health generates insights and drives cutting edge innovation through its clinical capabilities and deep understanding of health care informatics, physician management and health care technology systems development. Together, Evolent and New Century Health are harnessing the power of our combined organizations to improve the health of the nation. Join the New Century Health team and put your passion to work for transforming the U.S. health care landscape for patients, providers and payers.
What You’ll Be Doing:
The Senior Provider Network Manager is responsible for provider contracting and maintaining positive working relationships with all participating providers. Serves as the liaison between provider and New Century Health’s internal departments to address and resolve issues, as needed. Conducts provider in-servicing which provides a clear interpretation of organization’s policies and procedures related to various administrative/operations functions. Provides continuous provider education to all network providers. Responsibilities include:
– Responsible for incoming provider calls, documenting and resolving issues presented. Will seek the assistance of the Director, Network Solutions or call upon other departments as needed.
– Responsible for identifying provider targets and initiating/finalizing provider contract negotiations. Will seek assistance of direct supervisor when needed.
– Assists in developing provider in-service materials.
– Responsible for conducting provider in-services and educating network providers and supporting office staff on process/delivery system and company policies and procedures within the established time frames and thereafter as necessary.
– Responsible for utilizing only company approved educational materials that conform and are in compliance with all state, CMS or any other applicable regulatory agency.
– Responsible for communicating any updates to network providers in a timely matter.
– Conducts quarterly provider service visits or as needed.
– Assists upper management in analyzing network’s cost effectiveness, marketability, stability, and accessibility.
– Interacts and participates with other departments to accomplish company- wide goals and objectives.
– Under the direction of the appropriate department may assist in addressing provider related issues including but not limited to claims; utilization; member grievances and appeals; member complaints, provider grievances and appeals, etc. in a timely and professional manner.
– Completes departmental projects as requested.
– Assists health plan in member transitioning.
– Under direct clinical oversight and supervision, may assist in gathering certain information and follow-up on pending requests while following defined algorithms.
– Researches and identifies cause for specialty leakage, address, resolve and educate responsible parties.
– Responsible for all new market implementation activities supporting Network Operations, to include but not limited to, coordination and facilitation of key pre go-live market and provider introduction and deep-dive meetings.
– Identifies areas and coordinates changes where technology and workflow can assist in maximizing program results.
– Assists in creating training materials.
– Trains new team members.
– Represents NCH in JOC meetings with current clients.
– Assists with process implementation.
– Assists with backup support to team co-workers and manager.
– Acts with honor and integrity, serving as a role model for the company.
– Respects and maintains HIPAA confidentiality guidelines.
– Acts as an interdepartmental liaison between all New Century Health offices, departments, and committees.
– Performs other duties as assigned.
The Experience You’ll Need (Required):
– Bachelor’s degree (or equivalent experience)
– Minimum of Five (5) plus years’ experience in healthcare with strong emphasis in Provider Relations and/or Network Development.
– Strong knowledge of managed care terminology; broad knowledge of delivery systems and related industry terms.
– Excellent verbal, writing and presentation skills
– Excellent interpersonal skills
– Extremely organized and detail oriented with exceptional follow through skills
– Ability to multi-task in a fast pace environment; can adapt quickly to change; have strong negotiations skills
– Ability to conduct physician in-servicing (training sessions); excellent relationship building skills.
– Must have knowledge of Microsoft programs (i.e. Word, Excel)
– Ability to travel as needed.
– Bilingual English/Spanish preferred
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
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