Network Representative

Network Representative

Requirements

• Advanced-level business acuity
• Comprehensive knowledge and understanding of general/core job-related functions, practices, processes, procedures, techniques, and methods
• Advanced skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in other systems required for the position
• Ability and willingness to travel locally, regionally and/or nationally up to 80% of the time; flexible to work evening, weekends and/or holidays as needed
• Team-oriented with the ability to work extremely well with patients, colleagues, physicians, and other personnel in a professional and courteous manner
• Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks
• Spoken and written fluency in English
• This job requires use and exercise of independent judgment

Responsibilities

• Has direct accountability for total medical cost and quality of care external to ChenMed within the region.
• Builds, refines, and manages a tiered network of coordinated external specialists and facilities to form a Coordinated Provider List (CPL) for those specialties outside of HCT and Specialty Care. Local relationship builder with all providers and payor partners in the CPL.
• Identifies areas to improve provider service levels and quality. Leads a quarterly meeting National Specialty Directors and Network Director to review pattern, trends, and opportunities within the CPL.
• Responsible for meeting with high volume community specialist at least monthly to give them feedback on their referring trends and practice patterns as it relates to part B & D.
• Attends center meetings such as Transforming Care Meetings for to gain feedback about the CPL and educate PCPs about medical cost opportunities.
• Meets with individual PCPs regularly (usually monthly or more frequently as needed to support business need) to gain feedback about the CPL and provide targeted education about medical cost opportunities (A/B/D).
• Collaborates with Center Dyads to analyze, identify opportunities and support improvement initiatives within referrals including workflow, productivity, leakage and consult tracking.
• Coordinates utilization of CPL with Care Coordinators and Referral Managers: develops plans to reduce referral leakage.
• Maintains knowledge of medical trends, cost drivers and cost saving opportunities.
• Support communication and collaboration with health plans at the city/area and regional level.
• Performs other duties as assigned and modified at manager’s discretion.

Preferred Qualifications

• Healthcare experience within the Medicare HMO population is a plus
• Prior experience working in a Medicare Managed Care environment preferred