Provider Network Management Specialist Senior

Job Summary

Drive provider network strategies and solutions to improve outcomes and decrease medical expense trends. Develop and implement network engagement strategies linking strategic goals to the execution and renewal of alternative payment model contracts, through medical expense and utilization oversight of trend variance. Advance the requirements of business and quality improvement plans for assigned Accountable Care Networks and large practice groups.

Essential Functions

Responsible for contributing to the development and execution of provider strategy and solutions for assigned Accountable Care Networks. Substantially responsible for the execution of the strategy, including implementation of an annual strategic plan; coordinating and managing overall activities and developing strategies and approaches to help providers maximize performance potential

Provide relationship management and accountable care network oversight to support success in value-based contracts

Actively contribute to the Interdisciplinary Teams to ensure successful engagement of all parties

Lead the execution and implementation of payment programs, aligning economics with the business strategy to achieve lower per capita cost

Manage and implement programs to drive down total cost of care through utilization and medical expense trend oversight

Identify risk readiness for accountable care networks

Manage contract success through analysis of monthly reports

Provide mitigation solutions for gap closure and quality metric success

Qualifications

Required

Required bachelor’s degree in health care administration, business administration, accounting, finance, clinical or health and human services or equivalent education and experience

5 years of relevant experience of either provider network management experience, health care insurance or other health care delivery setting Required

Preferred

Master’s degree in health care administration or business administration or other relevant degree

2 years of relevant experience directly interacting in a clinical environment

Proven experience analyzing and assimilating financial and outcomes data

Knowledge of Patient Profiles and RPX reporting, and / or other reporting programs

Experience delivering presentations to a variety of audiences

Intermediate level knowledge of Microsoft Office Suite

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

Comprehensive benefits package to meet your financial, health, and work / life balance goals. Learn more here () .

On-demand pay program powered by Payactiv

Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

Optional identity theft protection, home and auto insurance, pet insurance

Traditional and Roth retirement options with service contribution and match savings

Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1239 E Beltline - Grand Rapids

Department Name

PH - Value Based and Affiliate Contracting

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 : 00 a.m. - 5 : 00 p.m.

Days Worked

Monday - Friday

Weekend Frequency

N / A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.