Mgr, Provider Relations

In addition to the responsibilities listed below, this position is also responsible for guiding the planning, development, and implementation of provider satisfaction strategies to improve network relationships and enhance provider engagement; coordinating teams efforts for the development of provider relations programs to facilitate effective provider communications and problem resolution; and training others to create and distribute media materials (e.g., articles and newsletters) and publications to providers; ensuring providers adhere to regulatory and contractual requirements; handling compliance issues or escalating to appropriate parties; guiding team to support organizational responses to regulatory audits; and coaching others on delivering provider education and/or onboarding.

Essential Responsibilities:

Provides developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works closely with employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; develops and provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Leads, adapts, implements, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams. Delegates tasks and decisions as appropriate; provides appropriate support, guidance, and scope; encourages development and consideration of options in decision making.

Manages designated work unit or team by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed. Aligns team efforts; builds accountability for and measuring progress in achieving results; determines and ensures processes and methodologies are implemented; resolves escalated issues as appropriate; sets standards and measures progress. Fosters the development of work plans to meet business priorities and deadlines; obtains and distributes resources. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams to execute in alignment with operational objectives.

Supports continuous improvement efforts by: coordinating efforts to use provider, claims, and contracting data when identifying and/or consulting on continuous improvement opportunities across the contract ecosystem (e.g., identifying business and operational disparities between organizational and provider expectations, constraints, and risks to accessible care, building and maintaining relationships); supervising the timely implementation of process improvement initiatives to aid providers and business goals; coaching team members to collaborate with internal and external partners to develop network strategies and implement improved access to care; and may also include leading the team to conduct and/or collaborate on advanced modeling and analyses of provider and market data to develop recommendations, solutions, and action plans for improvement initiatives.

Ensures contract commitments are met by: training the team to effectively analyze and summarize complex data of the day-to-day operation and management of services to consult on provider compliance; overseeing and guiding the documentation and reporting of provider activities and/or coordination with alternate stakeholders to ensure compliance with contract terms and conditions; enforcing the use of guidelines within the team to ensure provider compliance with state and federal regulations as well as KP policies and procedures; and guiding team in the consultation with Provider Systems Administration (PSA) or its equivalents needed to ensure proper contract interpretation and operational readiness and driving corrective actions as identified through contract performance.

Supports contract strategy development by: facilitating the development, proposal, and implementation of strategies that improve the quality of and access to patient care while managing outside service costs; coaching others to provide consultation on local service delivery planning to aid in the achievement of provider priorities and strategies; building strong collaboration in cross-functional workgroups and task forces to ensure provider strategies meet the unique needs of diverse stakeholders; and overseeing the development and/or delivery of peer training for new hires and contingent workers (e.g., establishing contract language, determining payment rate parameters, defining workflow and business processes, and ensuring cross-training across all service lines).

Grows the Provider Network by: training the team to identify or review recommended/potential partners/alliances for assigned service area to fill service gaps or decrease costs in current service offerings; leading the team to develop and maintain trusted partnerships with providers to understand their unique service request needs and challenges; serving as a trusted representative for providers and KP by facilitating the teams communication efforts (e.g., contract compliance such as access, availability, referral operations, and/or supporting member complaints); and supporting provider site visits, daily interactions, and ad hoc meetings by monitoring the development of itineraries and agendas, gathering credentialing materials, and/or initiating this process.

Contributes to provider satisfaction by: leading the team to develop knowledge of provider/contract operations to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, other operational issues, and/or directories; leading efforts to ensure requests for information, questions, and problems are identified, documented, and addressed in a timely manner; and managing the creation and delivery of training materials to aid provider education and orientation on health plan systems, processes, and/or credentialing.