Managed Care Network Representative

POSITION SUMMARY

The Managed Care Network Representative partners closely with facilities, providers, and other key healthcare professionals within assigned market to drive engagement and enhance performance in initiatives aimed at quality improvement, cost reduction, revenue optimization, and provider satisfaction for Allegiance Health Network’s clinically integrated network (“AHN CIN”). This role generally involves a minimum of 3 days per week in the field visiting providers onsite and is also responsible for ensuring the integrity of provider data being shared to internal teams for processing and maintenance.

**The ideal candidate is located in Central Louisiana and has experience in managed care.**

NATURE AND SCOPE

• Reports to: AHN COO
• Manages people: No
• Job status: Full-time; 40 hours/week (hours over 40 may be necessary at times)
• FLSA: Exempt
• Role requires frequent travel with the possibility of overnight stays

QUALIFICATIONS

• Experience working in healthcare, managed care, and/or health insurance
• Knowledge of CMS and Medicare Advantage payment methodologies and value-based contracting
• Strong interpersonal skills and high level of professionalism with ability to interact effectively across a wide range of individuals including physicians, office staff, hospital executives, other healthcare professionals, and internal team members
• Knowledge of healthcare systems and payer-provider dynamics with ability to negotiate and contract with healthcare providers
• Knowledge and understanding of CMS rules, regulations, and quality program measures and performance such as HEDIS, Star Rating System, Medical Loss Ratio, Risk Adjustment, etc.
• Ability to navigate through multiple computer applications and programs with ease including but not limited to Microsoft Office Suite (Word, Outlook, Excel, PowerPoint, etc.)
• Self-accountable, organized, and efficient with strong attention to detail and ability to meet deadlines and excel under pressure
• Highly adaptable and agile with effective time-management skills and ability to multitask and prioritize in a fast-paced, ever-evolving environment
• Must have and maintain a valid driver's license, clean driving record, and reliable transportation
• Health insurance broker license preferred

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Maintain high level of visibility within market through strategic schedule planning and clearly defined objectives and outcomes for each visit; complete accurate weekly log of all activity 
• Facilitate regular provider meetings to educate, disseminate data, and troubleshoot issues aimed at enhancing patient outcomes and operational efficiencies
• Work with population health team within clinics and at corporate level to provide guidance for quality improvement initiatives such as wellness exams, quality measures, risk adjustment, and other managed care opportunities within the organization
• Provide roster management and complete demographic forms with accuracy
• Coordinate and facilitate Joint Operational Committee meetings (“JOC’s”) to align strategies and goals
• Negotiate and contract with healthcare providers while ensuring their thorough comprehension of contractual obligations
• Hold providers accountable to contractual requirements and regularly report progress on performance plans to internal stakeholders, including leadership, with specific metrics and benchmarks for evaluation
• Maintain open communication channels with departmental leadership to ensure continued alignment with AHN priorities, strategies, and goals
• Other duties as assigned

Physical Requirements

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable qualified individuals with disabilities to satisfactorily perform these essential functions without causing an undue hardship for the employer.

• Remain in a stationary position for prolonged periods of time often standing or sitting at a desk and working on a computer
• Perform functions requiring repetitive motions that may include hands, wrists, and/or fingers
• Regularly move about the office to access file cabinets, office machinery, etc.
• Communicate effectively with clients and colleagues; hearing and speech are essential for this role
• Occasionally lift and/or move items up to 50 pounds