Responsible for developing and maintaining strong relationships with provider offices to improve network performance, enhance provider satisfaction, and support organizational growth.
Compensation
Pay Range: $54,434.00 - $81,651.00
Responsibilities
Build and maintain collaborative relationships with providers and their staff to support growth, retention, and performance improvement.
Partner with providers to improve performance on key performance indicators (KPIs) including growth, retention, Annual Wellness Visits, HEDIS gap closures, hospital and ER utilization, risk adjustment and other quality indicators.
Conduct initial provider onboarding and provide support for ongoing provider education on Alignment tools, clinical programs, PCP incentives, Member benefit offerings, Model of Care and other compliance requirements, and Alignment initiatives.
Assist in the development of training and educational materials/tools and create provider in-service and implementation packets.
Facilitate and serve as a single point of resolution for provider issues, including UM, prior authorization, claims, encounter data, eligibility, provider rosters and directory validation.
Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution.
Compensation
Pay Range: $56,200.00 - $101,000.00 per year
Responsibilities
Serve as primary contact for providers and act as a liaison between the providers and the health plan
Triages provider issues as needed for resolution to internal partners
Receive and effectively respond to external provider related issues
Investigate, resolve and communicate provider claim issues and changes
Initiate data entry of provider-related demographic information changes
Requirements
Bachelor’s degree in related field or equivalent experience
The Commercial Services (CS) Provider Recruitment & Market Development Manager is responsible for leading strategic provider recruitment and supporting the expansion of the organization’s national Independent Medical Evaluation (IME) provider network.
Responsibilities
Develop and execute strategic provider recruitment plans based on geographic coverage needs, client demand, specialty gaps, and organizational growth objectives.
Identify and recruit physicians and other qualified medical professionals to perform Independent Medical Evaluations and related services.
Conduct direct outreach to prospective providers through phone, email, networking, referrals, professional organizations, conferences, and in-person meetings.
Build and maintain strong relationships with physicians, practice managers, medical groups, and other healthcare organizations.
Educate prospective providers on the organization, IME services, expectations, scheduling models, and opportunities available within the network.
Requirements
Bachelor's degree in Business, Healthcare Administration, Human Resources, Marketing, or a related field preferred
For full-time positions, this pay range is for base per year; however, base pay offered within this range may vary depending on location, job-related knowledge, education, skills, and experience. A sign-on bonus and restricted stock units may be included in an employment offer.
Develop and grow positive, long-term relationships with physicians, providers and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan.
Locations (2)
Las Vegas, Nevada, United States
Nevada, United States
Compensation
$59,300 - $80,900 per year
Responsibilities
Develop and grow relationships with providers
Support financial and quality performance
Interpret and determine appropriate actions
Report to Director, Provider Engagement
Represent scope of health plan/provider relationship
The Physician Liaison drives new client referrals across all Apara markets, visiting pediatricians, psychologists, developmental specialists, and other referral sources to educate providers on ABA therapy and build relationships for new family intake.
The Physician Liaison drives new client referrals across all Apara markets, spending 4–5 days a week in the field visiting pediatricians, psychologists, developmental specialists, and other referral sources to educate providers on ABA therapy and generate new family referrals.
Foster and maintain strong partnerships between the healthcare organization and a diverse network of providers, ensuring seamless communication, contract negotiations, and network growth.
Responsibilities
Develop and maintain strong collaborative relationships with providers through high-touch communication to ensure network adequacy and quality and other provider performance goals are met.
Facilitate the development, negotiation, and execution of provider contracts, ensuring terms meet regulatory standards and organizational policies.
Monitor provider performance metrics and work with providers to implement corrective action plans when necessary.
Serve as the primary point of contact for all assigned providers, and as a link to various departments to address inquiries, resolve disputes, and maintain positive partnerships.
Maintain accurate records of provider interactions and follow up on outstanding issues to ensure timely resolution.
Requirements
Bachelor’s degree in Healthcare Administration, Business, or a related field.
Nice to have: Master’s degree in Healthcare Administration, Business, or a related discipline
Nice to have: experience working with managed care organizations or health insurance providers
Nice to have: familiarity with healthcare data analytics and performance measurement tools
Nice to have: demonstrated success in managing complex provider networks and multi-stakeholder projects
Qualtrics pays 100% of the healthcare benefit premiums for employees and their dependents
Variable allowances for wellness, meals, transportation, and more
Full-time employees are eligible for medical, dental, vision, life and disability, 401(k) with match, paid time off, a wellness reimbursement, and mental health benefits
Senior Consultant, Member ExperienceNewQualtrics · Remote, US
Physician LiaisonApara Autism Centers · St. Louis, US+5 more
Provider Relations Account ExecutiveIndependent Living Systems · Ocala, US
Medical Staff Services CoordinatorBJC HealthCare · Alton, US
Regional Director of Business DevelopmentCentral Florida Inpatient Medicine · Valdosta, US+2 more