Manager, Provider Relations (Hybrid Work Schedule)

Date: May 13, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7244 

 

Position Summary/Position

 

Under the supervision of the Director of Provider Relations, the Provider Relations Manager is responsible for the oversight and direction of the Provider Services Representative 1, 2 and 3 activities and personnel, assisting in the development of internal and external P&P, developing meaningful reports for use in JOM, ensuring the resolution of Member and Provider cases assigned to the PSR Team, interfacing with multiple departments to address Provider related concerns and motivating Team Members.

Major Functions (Duties and Responsibilities)

 

1. Develop PSR protocol to better serve our customers, both internal and external, while meeting regulatory and service level requirements. Monitor PSR activities, assess staffing needs and assure appropriate coverage to meet service level agreements.
2. Oversee IPA JOM activities, ensuring that JOM’s are scheduled timely, coordinated efficiently by the PSR’s and inclusive of all departments who work with the IPAs to create a meaningful agenda that drives towards improvement of CAHPs and HEDIS scores and emphasizes access and quality standards.
3. Attend meetings with IEHP departments including but not limited to the Monthly E&E meeting with Provider Services, Nurse Advice Line Committee, Web Portal meetings, monthly EDI and Web/IT meetings and Provider Network Update Process meetings.
4. Analyze grievance trend and CRM reports to evaluate access issues at a provider level and follow up on action plan.
5. Assist the Director of Provider Relations in the development and editing of both internal and external policies and procedures.
6. Conduct PSR Team meetings and oversee educational opportunities, working with the Provider Services trainer and Supervisors to develop and provide training to the PSRs on a frequent basis.
7. Support LEAN, utilizing A3 thinking with the PSR team to continuously improve processes.
8. Assist the Director of Provider Relations in addressing IPA concerns to ensure questions and issues are addressed in a timely manner.
9. Assist in the development of enhancements to the Provider portal and Provider Training Manuals.
10. Oversee the Provider Relations Supervisors and direct their activities.
11. Assist the Provider Relations Department as needed.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Three (3) or more years direct experience with Managed Care. Prior supervisory experience. Experience in spreadsheet and database manipulation.

Education Qualifications

 

Bachelor's degree from an accredited institution required.

Drivers License Required

Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement

 

Working knowledge of Medical Group and HMO operations, as well as NCQA credentialing and recredentialing standards.

Skills Requirement

 

Excellent written and verbal communication and interpersonal skills.  Strong organizational skills.

Abilities Requirement

 

Ability to establish and maintain effective working relationships with others. Ability to supervise and train team members, detailed oriented,  and computer proficient.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

Word processing involving computer keyboard and screens, automobile travel within the Inland Empire.

Work Model Location

Hybrid

 

Starting Salary: $103,708.80  - $132,225.60  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles