Network/Provider Rep.

We’re unique.  You should be, too.

We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Network Representative is responsible for the establishment of a Coordinated Provider List (CPL) to provide specialty care services to our patients within specific geographic regions. This individual will report to and work with the Network Director to develop the CPL and serve as the local relationship builder with those providers. This individual will use database systems to manage provider data and produce reports and analysis for the Center, Specialty, MED COE and HCT leaders to support improved medical costs and specialty care utilization. This individual will work closely with and consider feedback from those leaders as they develop the local CPLs. The Network Representative will also serve a key educational role for our PCPs. This individual will meet with the PCPs in their geographic regions in groups and also during 1:1 meetings to gain their feedback about the CPL while educating them about these providers while highlighting medical cost opportunities in their panel of patients.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Has direct accountability for total medical cost and quality of care external to ChenMed within the region.
• Builds, refines, and manages a tiered network of coordinated external specialists and facilities to form a Coordinated Provider List (CPL) for those specialties outside of HCT and Specialty Care.  Local relationship builder with all providers and payor partners in the CPL.
• Identifies areas to improve provider service levels and quality.  Leads a quarterly meeting National Specialty Directors and Network Director to review pattern, trends, and opportunities within the CPL. 
• Responsible for meeting with high volume community specialist at least monthly to give them feedback on their referring trends and practice patterns as it relates to part B & D.
• Attends center meetings such as Transforming Care Meetings for to gain feedback about the CPL and educate PCPs about medical cost opportunities.
• Meets with individual PCPs regularly (usually monthly or more frequently as needed to support business need) to gain feedback about the CPL and provide targeted education about medical cost opportunities (A/B/D).
• Collaborates with Center Dyads to analyze, identify opportunities and support improvement initiatives within referrals including workflow, productivity, leakage and consult tracking. 
• Coordinates utilization of CPL with Care Coordinators and Referral Managers: develops plans to reduce referral leakage.
• Maintains knowledge of medical trends, cost drivers and cost saving opportunities.
• Support communication and collaboration with health plans at the city/area and regional level.
• Performs other duties as assigned and modified at manager’s discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

• Advanced-level business acuity
• Comprehensive knowledge and understanding of general/core job-related functions, practices, processes, procedures, techniques, and methods
• Advanced skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in other systems required for the position
• Ability and willingness to travel locally, regionally and/or nationally up to 80% of the time; flexible to work evening, weekends and/or holidays as needed
• Team-oriented with the ability to work extremely well with patients, colleagues, physicians, and other personnel in a professional and courteous manner
• Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks
• Spoken and written fluency in English
• This job requires use and exercise of independent judgment

EDUCATION AND EXPERIENCE CRITERIA:

• BA/BS degree in Healthcare or related field is required OR additional experience above the minimum may be considered in lieu of the required education on a year-for-year basis
• A minimum of 3-5 years’ work experience in Healthcare or related field is required
• Healthcare experience within the Medicare HMO population is a plus
• A valid, active driver's license in State of employment is required; position may require travel within the market
• Prior experience working in a Medicare Managed Care environment preferred