issues and effectively communicates directly with physicians and the office staff. Identifies, pursues, and grows new membership and business opportunities. Maintains provider databases internally and externally with all CRC contracted health plans. n n Prospect Medical Holdings' ability to deliver quality, compassionate care during the unprecedented pandemic affirms the original vision of its founders.
This is the fulfillment of the hopes Prospect's founders had for the company, and proof that a clear vision, an insightful operating model, and a commitment to communities and our employees, born in the past, remains the way of the future. n n n n n n Every day, our more than 11,000 affiliated
physicians and 18,000 employees at 17 hospitals, 165 outpatient centers and 28 medical groups provide nationally recognized care in six states. Our comprehensive network of quality healthcare services is designed to offer our patients and 600,000 members highly coordinated, personalized care tailored to the unique needs of each community we serve-many of which provide essential medical services to underserved communities as safety-net hospitals.
n n Minimum Education: High School Diploma/GED required. Four (4) year college degree, preferred. n Minimum Experience: Proficiency in word, excel, pivot tables. Excellent verbal communication skills and interpersonal skills. Able to establish
rapport and interact well with individuals on all levels. Able to work with others while completing multiple tasks simultaneously and successfully.
Maintain a professional image and attitude. Exceptional customer service skills. Strong public speaking and presentation skills. Able to prioritize and organize multiple tasks. Ability to make decisions in the absence of detailed instructions and work independently or in a team environment. Experience generating strong leads for new business development opportunities including new Medicare/Medi-Medi conversions and/or IPA conversions. Minimum of 3 years of HMO/IPA/Health System experience in Provider Relations or Contracting, preferred.
Operations experience, preferred. Previous supervisory experience preferred. Must have advanced reasoning and problem solving abilities and planning skills. Ability to interpret a variety of instructions furnished in written, oral, diagram, and schedule form. Ability to speak, read, and writes English proficiently. Ability to write business correspondence. Ability to effectively present information and respond to questions from managers, employees, clients, customers and the general public. Demonstrate exceptional verbal/written/communication skills. Conducts routine visits to all providers to ensure performance compliance with revenue driven initiatives and focus on individual and IPA goals including, but not limited to the following: n n Engages in open face to face dialogue with physicians to communicate/educate important issues and updates.
n Ensures effective problem resolution and facilitate communication between CRC and Provider. n Ensures all assigned providers are compliant with company-wide initiativesn Ensures provider is well educated about CRC programs and implement specific workflows to meet initiatives and produce positive results. n Tracks and reports performance to measure results on a monthly basis and develop action plans for those non-compliant providers, with assistance from Network Manager.
n Ensures high level of participation by providers and office staff at all company events for education and training purposes. n Conducts Office Manager Meetings for assigned network physicians and develop plan to ensure high level of attendance. n Delivers and engages providers with Panel Reports in an effort to support care coordination/management and active engagement of High-Risk patients. n n In collaboration with the Network Manager, assists in identifying opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support company wide revenue goals including but limited to the following: n n Identifies and pursues contracts with primary care physicians who have membership growth opportunities and lead successful execution and implementation plan.
n Develops sales call plan for assigned region and achieve physician and membership goals for assigned territory. n Identifies and pursues business acquisition opportunities for senior management to explore and act as liaison between Prospect and physician through the review and implementation process.
n Identifies management opportunities with IPAs and groups and directing leads to senior management for review and consideration. n Performs/conducts Business Development functions to achieve membership growth to include: PCP recruitment, broker campouts, health plan representative and broker meetings, marketing strategies to promote growth, senior & commercial events, etc. n Actively works with network hospital(s) to identify and recruit new PCPs and high volume hospital admitters.
n Recognizes membership growth opportunities within established provider network and strategize methods to capitalize on growth via IPA consolidation, FFS Medi-Medi conversions into Managed Care product, Age in strategies, etc. n Identifies gains and losses and develop specific action plans to drive positive results for membership growth. n Tracks and trends growth and losses and report to management. n n Maintains IPA Master Provider Database and produce annual IPA Provider Directory. n n Perform the processing of new IPA Provider applications and agreements and provider terminations.
n Responsible for daily maintenance and accuracy of the IPA Provider Databasen Responsible for providing monthly IPA Provider list updates to all IPA contracted health plans and partners in format and structure required. n Process provider adds, changes and terminations using checklists to include configuration notification and health plan notification along with electronic file maintenance of contract. n Schedule and coordinate Health Plan JOCsn Maintain provider manuals for PCP and Specialists including in-service materials for network provider field visits. n Establish Cozeva and Aerial Care logins for providers and maintain records of logins provided.
n n IPA Governance - Responsible for all aspects of preparation for IPA Board and Committee and General Membership meetings including but not limited to the following: n n Work directly with RI CRC SVP on all Governance related activitiesn Ensure accurate and timely scheduling of all meetingsn Ensure agenda materials are prepared for senior leadership review at least 7 business days prior to the meetingsn Ensure agenda and materials are distributed prior to each meetingn Ensures all credentialing and recredentialing information is received timely.
n Conducts routine visits to all providers to ensure performance compliance with revenue driven initiatives and focus on individual and IPA goals including, but not limited to the following: n n Engages in open face to face dialogue with physicians to communicate/educate important issues and updates. n Ensures effective problem resolution and facilitate communication between CRC and Provider. n Ensures all assigned providers are compliant with company-wide initiativesn Ensures provider is well educated about CRC programs and implement specific workflows to meet initiatives and produce positive results.
n Tracks and reports performance to measure results on a monthly basis and develop action plans for those non-compliant providers, with assistance from Network Manager. n Ensures high level of participation by providers and office staff at all company events for education and training purposes. n Conducts Office Manager Meetings for assigned network physicians and develop plan to ensure high level of attendance. n Delivers and engages providers with Panel Reports in an effort to support care coordination/management and active engagement of High-Risk patients.
n n In collaboration with the Network Manager, assists in identifying opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support company wide revenue goals including but limited to the following: n n Identifies and pursues contracts with primary care physicians who have membership growth opportunities and lead successful execution and implementation plan. n Develops sales call plan for assigned region and achieve physician and membership goals for assigned territory. n Identifies and pursues business acquisition opportunities for senior management to explore and act as liaison between Prospect and physician through the review and implementation process.
n Identifies management opportunities with IPAs and groups and directing leads to senior management for review and consideration. n Performs/conducts Business Development functions to achieve membership growth to include: PCP recruitment, broker campouts, health plan representative and broker meetings, marketing strategies to promote growth, senior & commercial events, etc. n Actively works with network hospital(s) to identify and recruit new PCPs and high volume hospital admitters.
n Recognizes membership growth opportunities within established provider network and strategize methods to capitalize on growth via IPA consolidation, FFS Medi-Medi conversions into Managed Care product, Age in strategies, etc. n Identifies gains and losses and develop specific action plans to drive positive results for membership growth. n Tracks and trends growth and losses and report to management. n n Maintains IPA Master Provider Database and produce annual IPA Provider Directory. n n Perform the processing of new IPA Provider applications and agreements and provider terminations.
n Responsible for daily maintenance and accuracy of the IPA Provider Databasen Responsible for providing monthly IPA Provider list updates to all IPA contracted health plans and partners in format and structure required. n Process provider adds, changes and terminations using checklists to include configuration notification and health plan notification along with electronic file maintenance of contract. n Schedule and coordinate Health Plan JOCsn Maintain provider manuals for PCP and Specialists including in-service materials for network provider field visits.
n Establish Cozeva and Aerial Care logins for providers and maintain records of logins provided. n n IPA Governance - Responsible for all aspects of preparation for IPA Board and Committee and General Membership meetings including but not limited to the following: n n Work directly with RI CRC SVP on all Governance related activitiesn Ensure accurate and timely scheduling of all meetingsn Ensure agenda materials are prepared for senior leadership review at least 7 business days prior to the meetingsn Ensure agenda and materials are distributed prior to each meetingn Ensures all credentialing and recredentialing information is received timely.
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