• Manager, Provider Services

    Job Locations US-VA-Chesapeake
    Job ID
    2018-4945
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    This position is responsible for the direct administrative and supervisory activities of Provider Services in the Tidewater region to include recruitment and maintenance of a provider network in the region. In addition, this position is responsible for all internal and external provider communications. The Provider Services Manager will work directly with senior leadership to handle and direct issues, opportunities and processes.

     

    Responsibilities

    • Provide direct supervision and guidance to the Provider Services staff.
    • Provide guidance and oversight into key account management functions of regional Network, including health systems and priority providers.
    • Supervise staff efforts in all respects of achieving positive member and provider satisfaction.
    • Participate in the active recruitment and retention of plan providers.
    • Takes a leadership role to spearhead projects that have statewide impact and participation in company wide initiatives.
    • Identifies, develops and implements changes to statewide standard operating processes and policies specific to provider services.
    • Ensures prompt and efficient response to provider or provider related issues with appropriate, objective documentation of concerns, recommendations of resolution, monitoring and re-evaluation.
    • Performs site visits and in-services in accordance with company standards and guidelines.
    • Completes site visit reporting functions and identifies service related issues for resolution.
    • Assures compliance with operation policies and production standards that result in provider network adequacy and member retention.
    • Management of production and performance standards for provider services activities to include provider data maintenance, site visits and provider satisfaction surveys.
    • Identifies and implements, upon approval, cost management strategies and process improvement activities.
    • Leads all communications, marketing and provider educational materials/manuals for all LOBs, both internally and externally
    • Assists in the training and motivation of staff to carry out their assigned job functions.
    • Demonstrates comprehensive understanding of Department of Medical Assistance Services (DMAS) contractual requirements.
    • Exhibits a working knowledge of Virginia Premier systems including but not limited to IDX, QNXT, Vistar, Selectica and Provider Portals
    • Leads provider adoption for forward facing platforms (Clear Coverage, PaySpan, etc.)
    • Drives provider adoption for any forward facing provider application.
    • Perform other managerial duties as required.

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    •  Bachelor’s Degree in Health Services, Business Administration, Public Administration or other related business field.

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Understanding of Medicaid healthcare insurance markets, the HMO concept and business operations.
    • Proven technical and analytical skills
    • Ability to manage multiple projects while meeting deadlines and achieving business goals
    • Ability to supervise staff and promote successful performance
    • Proven presentation and written communication skills.

    WORK BACKGROUND/EXPERIENCE

    • Three (3) years managerial level supervisory experience
    • Proven track record with setting up and working with information systems.
    • Experience in Account Management or Sales position.
    • Healthcare or related experience working with providers and hospital organizations.

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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