Network Development and Engagement Representative- Ft. Myers Territory
It's inspiring to work with a company where people truly BELIEVE in what they're doing! When you become part of the Chapters Health Team, you'll realize it's more than a job.
It's a mission.
We're committed to providing outstanding patient care and a high level of customer service in our communities every day.
Our employees make all the difference in our success!Role:
The Network Development & Engagement Representative is responsible for assisting in the developing, maintaining and servicing a high quality, marketable and satisfied provider network within an assigned geographic area for Chapter Health System's Population Health Division in CareNu.
Focus includes recruitment and contracting; education and servicing of assigned providers by assisting providers to operate successfully.
Assists with performance and profitability for the assigned groups.
Qualifications:
Bachelor's degree in a related field; or an equivalent combination of education and experience A minimum of two (2) years of experience working with providers, provider groups, and ancillary providers in managed care preferred Strong understanding of business development, healthcare strategy, and value based Strong understanding of physician practice operations and associated performance metrics Working knowledge of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management preferred Provider recruitment and contracting experience preferred Fluent Spanish preferred Exceptional interpersonal skills with the ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, and other health plan staff Strong analytical and problem solving skills with effective follow through Excellent verbal and written communication skills including presentation skills to small and large groups Solid knowledge of local provider community preferred Ability to work with little supervision Mobile Driver - Valid driver's license and automobile insurance per Company policy Ability to travel to off-site locations; day travel 75% of the time Competencies:
Satisfactorily complete competency requirements for this position.
Responsibilities of all employees:
Represent the Company professionally at all times through care delivered and/or services provided to all clients.
Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
Comply with Company policies, procedures and standard practices.
Observe the Company's health, safety and security practices.
Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
Use resources in a fiscally responsible manner.
Promote the Company through participation in community and professional organizations.
Participate proactively in improving performance at the organizational, departmental and individual levels.
Improve own professional knowledge and skill level.
Advance electronic media skills.
Support Company research and educational activities.
Share expertise with co-workers both formally and informally.
Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
Job
Responsibilities:
Assists with developing and maintaining relationships with local providers to ensure network adequacy.
Introduces and advocates Chapters Health System and the affiliates to local provider networks via informational summits and events.
Conducts or assists with new provider orientations, ensuring providers and staff have in-depth understanding of contractual obligations, program incentives, and patient care best practices to facilitate practice optimization.
Maintains open dialog with providers to ensure they have the tools needed to resolve issues including quality, risk adjustment, and sustainable growth per business development plans.
Assists in the creation and supports a marketing plan for each service line.
Meets regularly with cross-functional teams to review and adjust plans based on detailed analysis of various reports.
Coordinates provider meetings to share and discuss economic data, issues related to credentialing, claims, eligibility, disease management, utilization management, and quality and risk adjustment programs.
Meetings to include scheduling, agenda, materials, location, food, and minutes.
In conjunction with the predictive analytics staff and the Medical Director, collaborates with provider groups to develop, execute and monitor performance and patient outcomes improvement plans.
Collaborates with the predictive analytics staff and the Medical Director to monitor utilization trends and profit pools and shares results with assigned Physicians.
Stays current on regulatory affairs and innovative payment models.
Collaborates with the contracting team to ensure provider data is correct and provider directories include any needed updates.
Completes Practitioner Data Forms and Provider Change Forms.
Provides support to maintain and develop ongoing value related to the CareNu Value Proposition.
Assists to identify at risk situations and aids in the development a plan for escalation and corrective actions.
Conducts site visits as required by NCQA.
Performs other duties as assigned.
This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.
Recommended Skills Analytical Business Development Claim Processing Communication Confidentiality Credentialing Estimated Salary: $20 to $28 per hour based on qualifications.
It's a mission.
We're committed to providing outstanding patient care and a high level of customer service in our communities every day.
Our employees make all the difference in our success!Role:
The Network Development & Engagement Representative is responsible for assisting in the developing, maintaining and servicing a high quality, marketable and satisfied provider network within an assigned geographic area for Chapter Health System's Population Health Division in CareNu.
Focus includes recruitment and contracting; education and servicing of assigned providers by assisting providers to operate successfully.
Assists with performance and profitability for the assigned groups.
Qualifications:
Bachelor's degree in a related field; or an equivalent combination of education and experience A minimum of two (2) years of experience working with providers, provider groups, and ancillary providers in managed care preferred Strong understanding of business development, healthcare strategy, and value based Strong understanding of physician practice operations and associated performance metrics Working knowledge of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management preferred Provider recruitment and contracting experience preferred Fluent Spanish preferred Exceptional interpersonal skills with the ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, and other health plan staff Strong analytical and problem solving skills with effective follow through Excellent verbal and written communication skills including presentation skills to small and large groups Solid knowledge of local provider community preferred Ability to work with little supervision Mobile Driver - Valid driver's license and automobile insurance per Company policy Ability to travel to off-site locations; day travel 75% of the time Competencies:
Satisfactorily complete competency requirements for this position.
Responsibilities of all employees:
Represent the Company professionally at all times through care delivered and/or services provided to all clients.
Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
Comply with Company policies, procedures and standard practices.
Observe the Company's health, safety and security practices.
Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
Use resources in a fiscally responsible manner.
Promote the Company through participation in community and professional organizations.
Participate proactively in improving performance at the organizational, departmental and individual levels.
Improve own professional knowledge and skill level.
Advance electronic media skills.
Support Company research and educational activities.
Share expertise with co-workers both formally and informally.
Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
Job
Responsibilities:
Assists with developing and maintaining relationships with local providers to ensure network adequacy.
Introduces and advocates Chapters Health System and the affiliates to local provider networks via informational summits and events.
Conducts or assists with new provider orientations, ensuring providers and staff have in-depth understanding of contractual obligations, program incentives, and patient care best practices to facilitate practice optimization.
Maintains open dialog with providers to ensure they have the tools needed to resolve issues including quality, risk adjustment, and sustainable growth per business development plans.
Assists in the creation and supports a marketing plan for each service line.
Meets regularly with cross-functional teams to review and adjust plans based on detailed analysis of various reports.
Coordinates provider meetings to share and discuss economic data, issues related to credentialing, claims, eligibility, disease management, utilization management, and quality and risk adjustment programs.
Meetings to include scheduling, agenda, materials, location, food, and minutes.
In conjunction with the predictive analytics staff and the Medical Director, collaborates with provider groups to develop, execute and monitor performance and patient outcomes improvement plans.
Collaborates with the predictive analytics staff and the Medical Director to monitor utilization trends and profit pools and shares results with assigned Physicians.
Stays current on regulatory affairs and innovative payment models.
Collaborates with the contracting team to ensure provider data is correct and provider directories include any needed updates.
Completes Practitioner Data Forms and Provider Change Forms.
Provides support to maintain and develop ongoing value related to the CareNu Value Proposition.
Assists to identify at risk situations and aids in the development a plan for escalation and corrective actions.
Conducts site visits as required by NCQA.
Performs other duties as assigned.
This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.
Recommended Skills Analytical Business Development Claim Processing Communication Confidentiality Credentialing Estimated Salary: $20 to $28 per hour based on qualifications.
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