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Sr. Provider Relations and Education Representative, RiverLink Health

Sr. Provider Relations and Education Representative, RiverLink Health

Job Description


The Provider Relations and Education Representative is responsible for cultivating productive relationships with health plan network providers. This role will be responsible for ensuring implementation and compliance with the Prominence national model for Provider Relations and Education. The Representative will serve as the single point of contact for the provider community and will initiate proactive provider outreach as well as provide superb provider service.

Key Responsibilities

  • Cultivate and maintain collaborative internal and external business relationships
  • Presents to provider groups and communicates directly with provider group representatives regarding policies and procedures and provider based initiatives
  • In conjunction with the medical management team, identify any areas of concern regarding medical policies presented by providers, medical cost targets and develop action plans related to those areas
  • Maintain current product knowledge including an understanding of the competitive environment
  • Identify and resolve provider concerns as primary contact point for Appeals and Grievances working in conjunction with Appeals and Grievance Coordinator
  • Communicate new service opportunities, special developments, information, or feedback gathered through field activity to appropriate company staff
  • Adheres to established internal controls, regulatory and fiduciary policies.
  • Collaborates within health plan operational areas to ensure consistency among functions and adherence to strategic plan
  • Provide support to marketing events such as seminars, trade shows, and telemarketing events

Core Expectations

At CHI, we expect all our employees to live the values of Reverence, Integrity, Compassion and Excellence by:

  • Honoring and caring for the dignity of all persons in mind, body, and spirit
  • Ensuring the highest quality of care for those we serve
  • Working together as a team to achieve our goals
  • Improving continuously by listening, and asking for and responding to feedback
  • Seeking new and better ways to meet the needs of those we serve
  • Using our resources wisely
  • Understanding how each of our roles contributes to the success of CHI.

Core Competencies

  • Financial Acumen:  Understands and can apply financial principles to business decisions; understands income statements, balance sheets, free cash flow, profit vs. cash.  Understands the impact of their decisions on CHI’s balance sheet and income statements.  Can coach direct reports around financial issues.
  • Business Acumen:  Knows how the functions of a business work and relate to each other; knows the impact of business decisions; knowledgeable in current and possible future policies, practices, trends, technology and information affecting his/her part of CHI.
  • Functional/Technical Skills: Has the expertise, knowledge and skills required to perform in his/her role and function at a high level of accomplishment; yet is not too narrow or does not depend upon technical and functional knowledge and skills at the expense of personal, interpersonal and managerial skills.
  • Clinical Skills:  Has met the standards expected of his/her role as a clinician in that particular function.  Stays abreast of trends and developments in his/her clinical field.
  • Other:  Examples include balancing work and life; balancing strategic and tactical focus; intellectual horsepower

Job Requirements

Job Requirements/Qualifications:

  • Education / Accreditation / Licensure (required and preferred)
  • Bachelor degree required

  • 2 years of experience in healthcare, preferably with payer
  • 2 years demonstrated success in provider relation activities
  • Demonstrated ability to work effectively in a matrix-oriented organization
Additional Responsibilities:
  • Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
  • Adheres to and exhibits our core values:
    Reverence: Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.
    Integrity: Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.
    Compassion: Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.
    Excellence: Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
  • Maintains confidentiality and protects sensitive data at all times.
  • Adheres to organizational and department specific safety standards and guidelines.
  • Works collaboratively and supports efforts of team members.
  • Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.
Catholic Health Initiatives and its organizations are Equal Opportunity Employers CB

  • Shift:  Day

  • Scheduled Hours per 2-week Pay Period:  80

  • Weekends Required:  None

  • Status:  Full Time
  • Job Snapshot

    Employment Type Full-Time
    Job Type Health Care
    Education 4 Year Degree
    Experience Not Specified
    Manages Others Not Specified
    Industry Healthcare - Health Services
    Required Travel Not Specified
    Job ID 1400022278
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    Sr. Provider Relations and Education Representative, RiverLink Health

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