Manager of Provider Engagement (MA)

Overview

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary Responsible for daily management, coaching and training of the Provider Engagement Team in the provision of all activities including oversight of department operations, provider servicing, orientations, education, site visits, metrics and data integrity. Leads MA Provider Relations team with product expansion, and necessary recruitment efforts. Develops and implements network-wide education and training plan on new products. This position is integral for overseeing the ACO relationships and the Provider Engagement team managing these accounts. Directly responsible for the successful implementation and continued support of these Strategic Partner relationships. This includes working directly and cohesively with ACO Operations Managers, Clinically Integrated Network teams and leadership to facilitate strategic partner activities.

Our Investment In You

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities

• Facilitate ongoing communication between the Plan and the Strategic Partner.
• Manage, track and resolve day to day concerns and/or activities.
• Support the timely and accurate completion of all reporting requirements.
• Facilitate resolution of Plan operational issues with input from subject matter experts.
• Manage the activities of complex work processes to achieve program goals.
• Support completion of regulatory and accreditation requirements.
• Ensure initiatives and tasks for provider orientations, trainings, education and service are appropriate as defined by Plan and for the customer, and that the provider network is successfully integrated with Plan’s medical management. The same may apply to provider recruitment and credentialing initiatives.
• Assist with provider implementation to ensure provider hierarchy and data are loaded appropriately in all relevant systems. This includes understanding and communicating unique arrangements and ensuring the Plan accurately administers those arrangements.
• Demonstrates knowledge of varying payment methodologies including but not limited to DRG, PCP Capitation, PCP sub-capitation, Fee-for-Service, Per Diem, Per cent of Charges. Exercises independent judgment and communicates effectively with other members of the Provider Relations Department.
• Oversees provider education activities including the development of presentations for orientations trainings for education.
• Assists our provider partners in the interpretation of data tools and analytics provided by the Plan, including Quality Incentive Programs (QIPs) reporting and other incentive programs developed.
• Identifies and assists with contract related efforts for qualified providers as needed to participated in Plan.
• Ensures provider implementation process is administered appropriately and verifies integrity of data to lessen provider claims issues.
• Ensures materials used with providers are accurate, updated, and appropriate for the situation presented.
• May assist with staffing of the Physician Advisory Board meetings in conjunction with Director of Provider Engagement and Plan Medical Director.
• Assists in the completion of semi-annual and annual state regulatory reporting related to MA Provider Engagement.
• Assists in the development and implementation of action plans related to provider satisfaction results and lead-time surveys.
• Gathers and analyzes competitive intelligence relative to provider network changes and trends in the marketplace.
• Oversees timely resolution of all provider issues and related escalations.
• Assists and analyzes Access and Availability issues within the provider network.
• Ensures provider compliance with contractual, regulatory and NCQA requirements and standards.
• Participates in cross-functional workgroups as requested. Maintains and reports as necessary on provider service standards.
• Responsible for employee annual performance reviews. Develops and monitors employee performance plans.
• Develops, revises, manages and utilizes a standard set of reports for Provider Relations Representatives to use in the education of providers.
• Monitors provider concerns and issues, communicating those issues to other functional areas within WellSense. Participates in processes for obtaining provider feedback to the Plan. Coordinates and assists in the appropriate response of the Plan on provider issues.
• Supports strategic network initiatives, consistent with the objectives of WellSense.
• Develops and maintains territory assignments for provider relations representatives.
• Other responsibilities as assigned which may include managing a provider territory
• Regular and reliable attendance is an essential function of the position

Supervision

• Supervises 5 - 7 staff

Supervision Received

• General supervision is received weekly.

Qualifications

Education Required:

• College Degree (BA/BS) or related field is preferred but not required.

Education Preferred

• College Degree (BA/BS) or related field is preferred but not required.

Experience Required:

• 3-5 years Healthcare/Provider Relations/Network Management experience required

Experience Preferred/Desirable:

• In addition, 2 or more year’s supervisory experience strongly preferred.

Required Licensure, Certification Or Conditions Of Employment:

• Successful completion of pre-employment background check
• Must have valid driver’s license and access to a car.

Competencies, Skills, And Attributes

• Understanding of the provider communities served
• Knowledge of federal Medicare, Medicaid regulations, guidelines and standards is a plus
• Proven demonstration of effective communication skills (verbal and written), and interpersonal skills to lead and direct the efforts of others, both internally and externally.
• Demonstrated ability to establish, build and maintain relationships with internal and external constituents
• Strong analytical, research and organizational skills
• Results oriented mindset and ability to mobilize multiple business areas to reach consensus and decision making
• Ability to influence others to achieve mutually beneficial outcomes and inspire trust
• Ability to think and react quickly to address questions and issues while interacting with the provider community
• Foster an atmosphere of collaboration and teamwork internally and externally
• Demonstrate initiative, judgment, discretion and ability to operate within politically sensitive framework
• Ability to be flexible, work independently and manage multiple tasks
• Demonstrated competence using Microsoft Office products especially Excel; familiarity with FACETS helpful

Working Conditions And Physical Effort

• Must be willing to travel to meet business needs required
• Ability to work in fast paced environment.

Compensation

Compensation Range
$86,500- $125,500

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note : This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees