Provider Engagement Manager
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
' Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
' Children's Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
' Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
' Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
JOB SUMMARY
The Provider Engagement Manager is a non-supervisory, primarily field-based individual contributor responsible for building and maintaining partnerships with providers, physicians, specialty groups, and facilities. The position provides field-based support and education related to new initiatives, access and availability, prior authorizations, claims issues, and Community's Provider Portal. The role owns an assigned provider portfolio and supports provider education, issue follow-up, practice improvement, scorecard delivery, and accurate provider and practice information.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Provider Relations and Partnerships:
Serve as a steward of information and education for assigned providers while maintaining awareness of practice structure, demographics, locations, services, and operational needs.
Serve as the primary point of contact for Community partners interfacing with the provider practice and its staff, engaging them as needed to support practice improvement.
Assume ownership of the post-recruitment phase of the practice cycle and support implementation of assigned initiatives.
Support alignment of practice operations with key elements of Community's Care Model.
Provider Education:
Ensure providers receive and review required initial and ongoing educational materials, including New Provider Orientation, the Provider Manual, and Quick Reference Guides.
Provide individual field-based and telephonic support and education on relevant operational topics.
Facilitate training in cultural care, HEDIS, STARS, and other applicable departmental topics.
Practice Improvement and Transformation:
Establish a regular meeting cadence with assigned provider practices to support practice transformation and improvement activities.
Develop and support improvement plans measured by cost, quality outcomes, provider satisfaction, HEDIS and STARS performance, contract goals, and value-based activities.
Support Quality and Population Health strategies and help ensure contractual requirements are implemented at the practice level.
Data Analysis and Reporting:
Deliver operational reports and scorecards to providers, using data analysis to communicate remediation opportunities and influence practice changes.
Identify operational workflows requiring remediation and escalate issues and recommended solutions to appropriate Community leaders.
Ensure accurate documentation and maintenance of provider and practice information.
Other Duties:
Perform other duties as assigned to support the department and organization.
QUALIFICATIONS:
Education/Specialized Training/Licensure: High school diploma or equivalent required.
Bachelor's degree in Business, Healthcare Administration, or a related field preferred.
Work Experience (Years and Area): Three (3) years of provider engagement, provider account management, provider contracting, practice management, or related healthcare experience.
Experience in a Managed Care Organization or health plan environment.
Software Proficiencies: Proficiency with Microsoft Office applications and web-based technologies.
Salesforce and QNXT.
Other: Travel is required approximately 75% of the time. Access to a vehicle and a valid Texas driver's license are required. Strong provider relations skills and understanding of risk and value-based contracting.
Familiarity with fee-for-service, capitation, global budget, performance compensation, and episode-of-care payment methods; knowledge of Member and practice risk adjustment mechanics and premium-based payment methodologies.