Provider Experience Manager
Must reside in WA - Teleflex Option
Provider Experience Manager manages the full provider experience externally, including education, communication, and problem resolution in order to build and maintain strong long-term provider relationships with provider partners. Cultivates and maintains relationships with contracted providers to support the successful execution of short, medium and long-term Cambia business objectives. Develops provider engagement activities across all lines of business, contracts, and initiatives. Responsible for engaging the provider in supporting organizational strategies to ensure a positive member experience. Manages cross-functional, cross-departmental relationships in support of effective provider partnerships and maintenance of network stability and adequacy.
- Builds trusting relationships externally with provider partners and internally with cross functional teams. Brings value and establishes credibility as a trusted advisor and resource to influence positive change while imparting a positive company image and professional demeanor.
- Manages the implementation of cross functional organizational strategies, including utilization management, provider data improvements, contracting, credentialing, and claims, focusing on improving the provider experience and member experience.
- Drives provider engagement in strategic health plan programs, including Medicare Advantage (MA) HMO activities, MA Quality Incentive Program with assigned provider groups, and adoption of new tools and technology. Promotes the focused use of available resources and tools to improve member health outcomes through provider engagement and enablement. Monitors progress and communicates performance expectations needed to result in better efficiencies for the provider and Cambia.
- Leads performance discussions with provider groups to create awareness of member gaps in care while overcoming objections to quality improvements to drive change.
- Plans and facilitates meetings with external providers for relationship maintenance, operational JOCs, VBA JOCs, and issue resolution.
- Collaborates with Provider Partnership Innovation team members in support of Value Based Agreements that are focused on the Quadruple Aim - increased quality, improved member experience, decreased cost, and improved provider experience.
- Coordinates to resolve escalated provider issues which may involve internal and external meetings.
- Develops and facilitates in-person or web-based, individual or group provider trainings using a variety of tools and technology.
- Collaborates with departmental contacts across the organization, as needed, in support of organizational strategies, resolving issues and improving processes and services.
- Negotiates and resolves complex contractual issues around reimbursement and medical policy,
- clinical edits, medical necessity and provider write offs.
Normally to be proficient in the competencies listed above
- Deep knowledge and understanding of the provider community and principles of healthcare delivery
- Strong communication and facilitation skills. Self-directed with creative problem-solving skills including the ability to identify problems, develop solutions, and implement a chosen course of action to resolve issues and build consensus among groups of diverse stakeholders.
- Ability to deliver challenging messages with diplomacy, while maintaining strong and trusting relationships with provider partners.
- Professional presence, leadership and influence skills, and knowledge of helping complex organizations affect change to improve their operating position.
- Strong critical thinking, consulting, communication (written and verbal), influencing, and facilitation skills at all levels of the organization, both internally and externally
- Proficiency in using Microsoft Office tools, including Word, Excel and presentation software.
- Demonstrated ability to effectively manage a variety of formal presentation settings; one-on-one, small and large groups and with peers; is effective both inside and outside the organization.
- Ability to work in a high-pressure environment and effectively manage conflict and ambiguity.
- Demonstrated ability to take initiative, working independently, prioritize work, and meet timelines.
- Ability to travel extensively within a designated geographic area.
- Knowledge of provider coding, documentation practices, reimbursement and contract methodologies. Familiarity with Regence product lines and benefit structures.
Provider Experience Manager would have a Bachelors degree in Healthcare Administration or related field and 8 years of experience in the healthcare industry with specific focus in provider relations, provider contracting, customer service, financial analysis or equivalent combination of education and experience. Valid driver's license is required.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.
This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com
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