Provider Relations Manager

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

The IEHP Provider Relations Manager (PRM) is responsible for network development, network adequacy and provider training and education, in alignment with IEHP’s overall mission, core values, and strategic plan and in compliance with all relevant federal, State and local regulations. More specifically, the PRM creates, develops and maintains strong relationships with IEHP\-Direct Providers (IEHP Direct providers are those who contract directly with IEHP as opposed to contracting with an IEHP delegated intermediary Provider organization) including but not limited to Primary Care Locations (“PCLs” which include Primary Care Physicians (PCPs) and mid\-level practitioners (Physician Assistants (PAs) and Nurse Practitioners (NPs), OB/GYNs, Urgent Care Centers (“UCs”), and other providers as assigned, including IPA\-affiliated providers for initial onboarding. In this role, the PRM will serve as the IEHP Subject Matter Expert (“SME”) on the providers assigned to them and will act as a “Success Liaison” for their Providers. The PRM serves as the primary point of communication with the Provider and maintains oversight of the relationship from inception of the Provider’s relationship with IEHP onwards.

In addition, the PRM will be responsible for recruiting new PCPs into IEHP\-Direct as well as identifying opportunities to develop the Specialty/Vision/Behavioral Health networks as needed to meet IEHP quality metrics, service goals and compliance standards.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary.
• Hybrid schedule.
• CalPERS retirement.
• State of the art fitness center on\-site.
• Medical Insurance with Dental and Vision.
• Life, short\-term, and long\-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work\-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Education \& Requirements

• Three (3\) or more experience with customer service
• One (1\) year of experience including Hospital, Managed Care, Medical Group, IPA, and HMO
• Experience with managed care
• Bachelor's degree from an accredited institution required

Key Qualifications

• Must have a valid California Driver's License and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3\) points
• Working knowledge of Medical Group IPA and HMO operations
• Strong organizational skills
• Excellent written and verbal communication and interpersonal skills
• Microcomputer Applications (Microsoft Word and Excel, Access Preferred) for use in all aspects of an office environment
• Skilled data input
• The PRM should demonstrate a strong sense of ownership of IEHP’s relationship with the Provider that recognizes the Provider as a valuable partner
• Ability to proactively engage with the Provider and staff to determine root cause and address business issues (such as administrative, regulatory and customer service matters)
• Ability to train and educate Providers and Provider staff as needed, which may include counseling providers diplomatically, while retaining a positive working relationship
• Ability to independently troubleshoot and problem\-solve issues as they arise, making an assessment when escalation to a Senior Provider Relations Manager, Supervisor, or another IEHP department as needed and initiating, coordinating, and participating in problem\-solving meetings between the Provider and IEHP stakeholders, including senior leadership and Providers. Take initiative in preventing and resolving issues between the Provider and IEHP whenever possible.
• Independently deliver training and presentations to assigned Providers and their staff, answering questions that come up on behalf of IEHP. May also deliver training and presentations to larger groups, such as leaders and management of Provider offices.
• Ability to perform as an integral role in network development, by monitoring and enforcing company policies and procedures, while increasing Provider effectiveness by educating and promoting participation in various IEHP initiatives. Examples of such initiatives include administrative cost effectiveness, member satisfaction \- CAHPS, regulatory\-related, IEHP Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.)
• Data entry involving computer keyboard and screens, automobile travel within the IEHP service area, distribution of reports and supplies to outside provider offices.

Start your journey towards a thriving future with IEHP and apply TODAY!