Inland Empire Health Plan
Provider Relations Manager
Inland Empire Health Plan, Rancho Cucamonga, California, United States, 91739
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an
authentic experience!
Join us as a Provider Services Representatives at IEHP, where you’ll be the linchpin in cultivating and maintaining robust relationships with our Providers. Be at the forefront of organizational policies, delivering trainings, and driving network improvement plans. Act as a provider Advocate, resolving issues and championing IEHP’s quality metrics and service goals. Dive into Provider visits, strategically focusing on high-volume providers to align with our quality initiatives. Lead investigations, support through utilization reports, and promote electronic submission capabilities for HEDIS metrics. Collaborate with various departments, attend meetings, and be a vital part of Provider relations.
Key Responsibilities:
PROVIDER ENGAGEMENT (RELATIONSHIP / QUALITY / OPERATIONS / STRATEGIC INITIATIVES)
Provide in-person New Primary Care Location (PCL) in-service on a timely basis.
Partner with the provider to provide PCL, establish Meaningful Engagement cadence and PCL-specific content.
On a monthly basis, provide in-person or as requested, Meaningful Engagements to established PCLs; no less than 10/year.
Provide in-person or as requested New Provider in-service for UCs and OBGYNs; establish Meaningful Engagement cadence.
On a quarterly or as requested basis, provide in-person or telephonic Meaningful Engagements to non-PCLs.
Provide Strategic Engagements with PCLs as requested by other IEHP Departments, including but not limited to Quality, Health Education, Health Services, and Strategy.
Maintain accurate and timely log of Provider visits in compliance with NCQA standards, and DHCS and CMS regulatory requirements.
PROVIDER NETWORK DEVELOPMENT
Recruit new PCLs into IEHP-Direct.
Add IEHP-Direct Link to existing PCPs/PCLs.
Identify potential new specialty/vision/behavioral health service Providers.
PROVIDER CONTRACTING
Take lead in all contracting activity and communications for new PCLs.
Provide support to the Contracting Department and maintain ongoing Provider communication with new UCs, OBGYNs, and other specialists as requested.
Coordinate with Contracts Department to address Provider inquiries concerning rate/service changes and claims disputes.
PROVIDER CREDENTIALING SUPPORT
Take lead in obtaining all credentialing collateral as required for new PCLs and their Physician Extenders (PE).
Provide credentialing department support and ongoing Provider communication with new UCs, OBGYNS, and other Specialists as requested.
Provide credentialing department support and ongoing Provider communication with existing Specialists during recredentialing process as requested.
PROVIDER ON-BOARDING & ACTIVATION
Manage New PCL On-Boarding Checklist activities.
Assist in managing New Specialist On-Boarding Checklist activities.
PROVIDER MARKETING & MEMBERSHIP GROWTH
Perform Membership Growth Assessment for PCLs as requested or directed; identify opportunities for growth.
Coordinate development of PCL-specific Membership Growth Plan.
Partner with PCL and IEHP Marketing & Sales Team to implement the Membership Growth Plan.
ETHICAL AND PROFESSIONAL CONDUCT
Promote the highest standards of ethical and professional conduct to Team Members through demonstrated individual performance.
PROGRAMS, POLICIES AND PROCEDURES AND DATABASES AND SYSTEMS
Stay current on all aspects of the IEHP programs, policies, and procedures as they relate to the Providers of IEHP, including IEHP lines of business and Member benefits. Proficiency in utilization of all Provider Services databases and systems.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits:
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
CalPERS retirement
457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account – Health Care/Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities
Qualifications:
Education & Experience
Bachelor's degree from an accredited institution required.
Three (3) or more years of experience with customer service.
One (1) year of experience including Hospital, Managed Care, Medical Group, IPA, and HMO.
Key Qualifications:
Excellent written and verbal communication and interpersonal skills. Microcomputer Applications (Microsoft Word and Excel, Access Preferred) for use in all aspects of an office environment.
Strong organizational skills.
Skilled data input.
Start your journey towards a thriving future with IEHP and apply
TODAY!
Pay Range: USD $34.41 - USD $44.73 /Hr.
#J-18808-Ljbffr
Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an
authentic experience!
Join us as a Provider Services Representatives at IEHP, where you’ll be the linchpin in cultivating and maintaining robust relationships with our Providers. Be at the forefront of organizational policies, delivering trainings, and driving network improvement plans. Act as a provider Advocate, resolving issues and championing IEHP’s quality metrics and service goals. Dive into Provider visits, strategically focusing on high-volume providers to align with our quality initiatives. Lead investigations, support through utilization reports, and promote electronic submission capabilities for HEDIS metrics. Collaborate with various departments, attend meetings, and be a vital part of Provider relations.
Key Responsibilities:
PROVIDER ENGAGEMENT (RELATIONSHIP / QUALITY / OPERATIONS / STRATEGIC INITIATIVES)
Provide in-person New Primary Care Location (PCL) in-service on a timely basis.
Partner with the provider to provide PCL, establish Meaningful Engagement cadence and PCL-specific content.
On a monthly basis, provide in-person or as requested, Meaningful Engagements to established PCLs; no less than 10/year.
Provide in-person or as requested New Provider in-service for UCs and OBGYNs; establish Meaningful Engagement cadence.
On a quarterly or as requested basis, provide in-person or telephonic Meaningful Engagements to non-PCLs.
Provide Strategic Engagements with PCLs as requested by other IEHP Departments, including but not limited to Quality, Health Education, Health Services, and Strategy.
Maintain accurate and timely log of Provider visits in compliance with NCQA standards, and DHCS and CMS regulatory requirements.
PROVIDER NETWORK DEVELOPMENT
Recruit new PCLs into IEHP-Direct.
Add IEHP-Direct Link to existing PCPs/PCLs.
Identify potential new specialty/vision/behavioral health service Providers.
PROVIDER CONTRACTING
Take lead in all contracting activity and communications for new PCLs.
Provide support to the Contracting Department and maintain ongoing Provider communication with new UCs, OBGYNs, and other specialists as requested.
Coordinate with Contracts Department to address Provider inquiries concerning rate/service changes and claims disputes.
PROVIDER CREDENTIALING SUPPORT
Take lead in obtaining all credentialing collateral as required for new PCLs and their Physician Extenders (PE).
Provide credentialing department support and ongoing Provider communication with new UCs, OBGYNS, and other Specialists as requested.
Provide credentialing department support and ongoing Provider communication with existing Specialists during recredentialing process as requested.
PROVIDER ON-BOARDING & ACTIVATION
Manage New PCL On-Boarding Checklist activities.
Assist in managing New Specialist On-Boarding Checklist activities.
PROVIDER MARKETING & MEMBERSHIP GROWTH
Perform Membership Growth Assessment for PCLs as requested or directed; identify opportunities for growth.
Coordinate development of PCL-specific Membership Growth Plan.
Partner with PCL and IEHP Marketing & Sales Team to implement the Membership Growth Plan.
ETHICAL AND PROFESSIONAL CONDUCT
Promote the highest standards of ethical and professional conduct to Team Members through demonstrated individual performance.
PROGRAMS, POLICIES AND PROCEDURES AND DATABASES AND SYSTEMS
Stay current on all aspects of the IEHP programs, policies, and procedures as they relate to the Providers of IEHP, including IEHP lines of business and Member benefits. Proficiency in utilization of all Provider Services databases and systems.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits:
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
CalPERS retirement
457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account – Health Care/Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities
Qualifications:
Education & Experience
Bachelor's degree from an accredited institution required.
Three (3) or more years of experience with customer service.
One (1) year of experience including Hospital, Managed Care, Medical Group, IPA, and HMO.
Key Qualifications:
Excellent written and verbal communication and interpersonal skills. Microcomputer Applications (Microsoft Word and Excel, Access Preferred) for use in all aspects of an office environment.
Strong organizational skills.
Skilled data input.
Start your journey towards a thriving future with IEHP and apply
TODAY!
Pay Range: USD $34.41 - USD $44.73 /Hr.
#J-18808-Ljbffr