Provider Network Manager- St. Louis or Cincinnati

naviHealth - Ohio (30+ days ago)3.3

  • Ideal candidate will be located in or near Cincinnati, OH or St. Louis, MO metro area*
Why naviHealth?

naviHealth is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time. How might you ask? By hiring talented clinicians, engineers, analysts, and healthcare leaders to create and utilize cutting edge technology to provide the patient with the best level of care for the right amount of time.

Why Is This Role Critical?

nH recognizes the vital role providers play in enhancing our service delivery to the member. A highly engaged provider network is critical to ensure members receive the right care at the right place for the right amount of time. The Network Manager (NM) is an integral part of the In-market leadership team, also including: General Manager, Senior Clinical Manager, and Clinical Team Manager. The NM develops and maintains an ongoing collaborative relationship with providers, based on mutual respect, high quality outcomes and patient satisfaction. The NM works to continually shape the Network landscape, by offing objective data and education to all stakeholders in the market. In its highest functional state, it’s the NM whom supports the provider in ensuring recognition by the hospital and plan partners through appropriate rate setting, improved volume and achieving and maintaining PAR/Contracted status. The NM plays a vital role in achieving positive outcomes in the market including but not limited to: SNF LOS, Discharges to PAR/Contracted Providers and Closing Clinical Records.

What you will be accountable for….

Responsible to develop relationships with providers/payers and supporting the patient centric model during new implementations:
Creates database of pre-implementation provider metrics (e.g. readmission rates, ALOS, etc.)
Coordinates of implementation activities (scheduling dates/locations, speakers/attendees, contact points, deck preparation, status updates, etc.)
Creates plan approved provider facing educational and summary documents
Ensures all necessary logistics obtained to support a successful implementation (contacts, EMR access, onsite access, etc.)
Coordinates onsite requirements for naviHealth colleagues (e.g. credentialing, legal requirements, etc.)
Responsible to maintain positive working relationships with providers/payers to build a high quality, highly receptive network base in mature markets.
Serve as main point of contact for provider
Delivers provider and hospital performance information at a regular cadence

Holds providers accountable to:
Professional collaboration (based on collaboration agreement)
Timely delivery of clinical information
Supporting patient and family access to the nH Care Coordinator
Evaluates provider receptiveness and quality
Responsible to lead network issue resolution
Identifies challenging situations early and ensures appropriate action taken to mitigate escalation.
Support providers as they have questions / concern / suggestions
Solicits feedback as appropriate (focus groups, survey, coalitions)
Works to resolve provider complaints at a local, regional and national level
Develop ongoing support materials for providers
Preparation and analysis of dashboards for providers
Coordination and delivery of dashboard information to providers (SNF and hospital as indicated)
Provides ongoing education to providers that promotes quality service and collaboration
Works closely with General Manager and Senior Clinical Manager

Monitors and works to improve:
hospital DC referral patterns
par and non-par SNF LOS
closed record statistics
Reports challenges with care coordinators in the field
May participate in network narrowing strategies
Works closely with VP Provider Engagement
Analyzes data for trends in performance on a market, client, regional and national level
Supports new and existing strategic network initiatives and programs
Communicates network initiatives to providers
Supports company specific initiatives as appropriate
Supports the marketing of the nH brand
Supports the onboarding of new network colleagues through mentorship
Works with internal resources on development of preferred provider networks
Supports and implements pay for value programs, as applicable
As indicated, assist with the development contracted networks
Executing direct contracts with post-acute care providers
Participating in contract negotiations and contract language review including redlining
Managing contract load process
What you will need to be successful……

Bachelor’s degree or equivalent;
5+ Years in a customer facing or Account Management Role
Effective negotiation and influencing skills
Detail oriented
Ability to build and foster relationships inside and outside the organization
Ability to independently plan, organize and prioritize work
Willingness to work toward team objectives
Ability to manage direct reports or team members
Ability to make appropriate organizational determinations in accordance with nH standards of practice independently and timely
Experienced in managed care, health plan operations in provider contracting, customer service, or provider relations
Strong brand promotion and management skills
Data analytics and reporting experience required
Proficiency with Microsoft Office applications
Experience in Acute and Post-Acute Care Continuum a plus
Clinical Degree may be required, based on the needs of the market
Extensive travel may be required
About Us

naviHealth is a pioneer in post-acute care and care transitions with a combined unprecedented 18 year of experience that uniquely positions us to manage patients, improve clinical and financial outcomes, and share risk with payors and providers. As a Cardinal Health company, we provide clinical support alongside scalable technology and advisory solutions that empower health systems, health plans, and post-acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes

naviHealth Values

We care about the people we serve.

We care about each other.

We care about our communities.

We embrace innovation.

We like simple.

naviHealth ™ is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.