Provider Engagement & Experience Manager (Available for NC) Position Available In Mecklenburg, North Carolina

Provider Engagement & Experience Manager (Available for NC) 3.9 3.9 out of 5 stars Davidson, NC Competitive Compensation & Benefits Package! Position eligible for

• Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details.

Office Location:

Available for the any of Partners’ NC locations

Closing Date:

Open Until Filled Primary Purpose of Position:

The Provider Engagement and Experience Manager engages the contracted network to maintain partnerships between the health plan and the contracted provider network serving our communities. This role is a high functioning, strategic champion of provider support and engagement. Engages with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. This position works collaboratively and across departments to assist with development and implementation of strategic initiatives and projects directed at improving provider engagement and experience in the Partners’ provider network and services to internal and external stakeholders. They engage internally and externally in areas such as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, as indicated, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Drive optimal performance in contract incentive performance, quality, and cost utilization. The Provider Engagement and Experience Manager works strategically with the providers and physicians with the purpose and aim of building a partnership with providers to actively participate in quality improvement initiatives and value-based care models. Provider engagement involves deeper communication and collaboration with providers, often including data sharing, educational programs, and feedback loops to align goals and improve care delivery.

Role and Responsibilities:

Work with the Provider Engagement and Experience Director to build out clinical education sessions for providers on guidelines created by the health plan. Supports providers and quality by sharing patient data analytics to identify areas for quality improvement as a useful resource for providers to ensure success in the Partners’ provider network and support of the Provider Support Plan. Supports Provider Education for the providers in the network by conducting new provider onboarding and training to familiarize providers with working with Partners and meeting contractual obligations and compliance. Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, Electronic Data Interchange (EDI) solicitation and related topics. Works to ensure and support excellent inter-departmental communications for key coordination activities to ensure network performance standards are met. Maintain and build strong business relationships with Providers and champion their requests to ensure a positive Provider experience and instill confidence in the Partners’ brand. Works collaboratively with the Population Health and Quality Management Departments to implement incentive programs based on quality metrics. Assists in conducting regular provider satisfaction surveys to understand network provider and physician needs and concerns. Supports successful program implementation through cross functional collaboration of the provider support plan. The Provider Engagement and Experience Manager will understand, commit to and embed the principles of equity, effectiveness, and efficiency into every facet of the provider/physician engagement to educate physicians and network providers on understanding the benefits of improved healthcare and ensuring their understanding of the equitable distribution across all societal segments. Embracing this comprehensive framework addresses immediate healthcare challenges and paves the way for a future where every individual, regardless of their circumstances, has access to high-quality healthcare. Works cross functionally with leadership of Provider Network to support successful NCQA Accreditation and compliance towards contractual requirements. Leads a team of Provider Engagement staff (PES) working with Strategic Providers to improve Quality outcomes. Supports and assists the Provider Network Engagement Director to implement strategy and operational initiatives. Coordinates and facilitates PES team meetings, including meeting agendas, minutes, handouts, and monitoring action items to completion. May lead or participate in one or more teams from multiple disciplines (Quality, Provider Services, Clinical, Operations) to engage with key providers. Supports the maintenance and tracking of Provider Engagement Staff activities and regularly collects, monitors and disseminates reporting to Provider Engagement Staff. Builds internal relationships to develop a TEAM approach to Provider Engagement. Builds and nurtures positive relationships between strategic providers and Plan. Supports provider orientations and ongoing provider education, including writing and updating orientation materials and provider materials. Supports Network performance for the plan through a consultative/account management approach Supports provider performance and strategic initiatives to improve performance Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc. Works collaboratively with Marketing and Communications and Training and Education departments to ensure that all materials meet company standards. Triages provider issues as needed for resolution to internal partners Receive and effectively respond to external provider related issues Completes special projects as assigned Performs other duties as assigned Complies with all policies and standards

Knowledge, Skills and Abilities:

Comprehensive knowledge of mental health, substance use and intellectual and developmental disabilities and service delivery systems for the entire spectrum of client categories including an understanding of principles, concepts and Best Practices used in the treatment, habilitation, and support of individuals with needs in any of the disability areas General knowledge of Partners Strategic Plan, Quality Management Plan, Provider Support Plan. Comprehensive Knowledge of Physical Health Practice supports, HEDIS Measures, closing care gaps and practice communication. Must have knowledge of Medicaid Transformation and Managed Care Knowledge of the laws, regulations and programs impacting mentally ill, substance abusing and intellectually and developmentally disabled clients and their families Must understand LME/MCO goals, targets, and outcomes in relation to the responsibilities and supporting relationships of the Network Management Department A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance, requiring exceptional interpersonal skills, teambuilding skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts Problem solving, negotiation, arbitration, and conflict resolution skills are essential to balance the needs of both internal and external customers Requires public speaking and mediation skills to facilitate collaboration and positive relationships between teams, families/consumers, and agencies Demonstrated ability to write and distribute communications and education material on a small or large scale following mandated brand and communication guidelines. Knowledge of contact distribution types such as constant contact, etc. Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, PowerPoint) Ability to review and analyze data to evaluate program effectiveness, progress, problems, and system performance Ability to establish and maintain positive and effective working relationships with leadership and staff, stakeholders, and local/state/federal officials Managed care knowledge of data systems, database management, provider networks, claims payment and/or clinical services. Managed healthcare industry knowledge and including management of complex, interdependent functions. This position requires an individual to be highly organized, have a keen attention to detail, and the flexibility to work with different aspects of a business. Must have management and supervisory skills, communication, organization and staffing skills, as well as knowledge of financial and budgeting practices and principles. Strong verbal and written communication skills are important in this position to work well with a variety of employees and sometimes with clients and outside vendors Willingness to establish and maintain effective working relationships with others as a team by offering support and/or ideas to enable staff to reach goals. Change Management

• Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results. Leadership
• Exhibits confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Accepts feedback from others. Managing People
• Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates’ activities; Makes self-available to staff; Provides regular performance feedback; Develops subordinates’ skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others.

Quality Management/Quality Improvement approach

• Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.

Improves processes, products, and services. Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies Demonstrated ability to manage multiple projects and meet deadlines

Education/Experience Required:

Bachelor’s Degree in mental health, public health, social work, psychology, education, sociology, business, or public administration and five (5) years of experience in a community, business, or governmental program in health-related fields, social work or education. At least five (5) years’ experience in physical health network operations, network management, provider relations and management experience, and/or health care managed care provider contracting. Three (3) three years of supervisory, consultative, or administrative experience. A combination of relevant experience may be considered in lieu of a bachelor’s degree. NC Residency is required.

Education/Experience Preferred:

Master’s Degree in mental health, public health, social work, psychology, education, sociology, business, or public administration and five (5) years of experience in a community, business, or governmental program in health-related fields, social work or education including experience in network operations, provider relations and management experience. At least five (5) years’ experience in physical health network operations, network management, provider relations and management experience, and/or health care managed care physical health provider contracting. Three (3) years of supervisory, consultative, or administrative experience. A valid driver’s license is required. NC Residency is required. Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance

Licensure/Certification Requirements:

None