Job Description

Supervise daily operations and provide leadership, support, and direction to assigned ProviderRelations Representative staff. Ensure the highest level of customer service is a priority of PRstaff. Monitor department goals and meet deadlines. Recruit and retain Provider network.

Responsibilities

• Supervise daily operations of assigned PR Representatives.
• Provide leadership, direction, support, and daily supervision to staff.
• Promote professionalism, positive attitudes, team work, and fun in the workplace.
• Conduct weekly staff meetings.
• Provide weekly and/or monthly performance feedback to PR Representative staff.
• Conduct annual performance evaluations.
• Provide staff development, monitor staff performance, and provide counseling.
• Monitor REP visit logs, score cards, department goals, and ensure compliance.
• Interview and participate in selection of PR Representative staff.
• Resolve provider inquires and problems.
• Assist with resolution of provider expressions of dis-satisfaction, appeals and grievances.
• Develop provider training materials in collaboration with SR Manager of Network Educationand Credentialing
• Supervise provider survey activities for DHCS, NCQA and other Regulatory agencies.Ensure timelines are met, develop corrective action plans.
• Attend early morning and late evening provider/Partnership meetings.
• Coordinate new provider recruitment and contracting activities with Contracts staff asneeded.
• Participate in special projects and assignments, ensure deadlines are met..
• Coordinate and Monitor provider network trainings.
• Ensure PR Representatives meet provider visits goals, monitor issues identified duringvisits, and develop action plans with PR Representatives to address problems.
• Participate in DHCS annual audits as assigned
• Assist with documentation to meet NCQA requirements
• Active member of the Partnership CERT team
• Participate in Partnership Team and Dept. goals
• Ensure daily operations and servicing goals are met if REP staffing issues occur
• Facilitate the scheduling of NR/SR combined REP meetings
• If applicable, retain the day to day servicing of the assigned county provider network

SECONDARY DUTIES AND RESPONSIBILITIES

• Back up to Director or Senior Provider Relations Representative Manager as directed.

Qualifications

Education and Experience

Bachelor’s degree in Healthcare, Marketing, Public Relations, or relatedfield; minimum three (3) years in healthcare, marketing, or public relationsexperience in a managed care environment preferred; or equivalentcombination of education and experience. Two (2) years of experience asa Provider Relations Representative.

Special Skills, Licenses and Certifications

Working knowledge of business software applications. Knowledge ofmanaged care concepts, policies, and procedures. Ability to disseminateMediCal policies and procedures. Valid California driver’s license andproof of current automobile insurance compliant with Partnership policy arerequired to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communication skills. Excellent organizationskills with the ability to prioritize assignments, maintain accurate records,and meet deadlines. Ability to use good judgment in making decisionswithin scope of authority and handle sensitive issues with tact anddiplomacy.

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 30% of work time is spentin front of a computer monitor. When required, ability to move, carry, orlift objects of varying size, weighing up to 35 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$93,690.86 - $117,113.58

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.