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  • Farmington, CT

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Network Relations Account Manager

ConnectiCare • Farmington, CT

Posted 1 month ago

Job Snapshot

Full-Time
Other Great Industries
Management

Job Description

ConnectiCare is a leading health plan in the state of Connecticut.  ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
 

We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.

Summary:   Serves in an account management (non-sales) role as the primary interface between ConnectiCare and its provider network.  Continuously educates provider community about ConnectiCare and its policies and procedures. Build and develop partnerships with ConnectiCare’s Tier I and Tier II providers, driving engagement and advocacy.  The Account Manager develops and maintains an ongoing collaborative relationship with providers, based on mutual respect, high quality outcomes, patient satisfaction and reporting. The Account Manager plays a vital role in achieving positive outcomes in the market.

Responsibilities:

  • Develop and maintain positive business relationships with Tier 1 providers, and support of Tier II providers in alignment with departmental objectives.
  • Oversee the compliance and participation of network physicians to ensure providers are responding timely and accurately to global requests made by any and all departments within the organization.
  • Actively participates in internal Provider Collaborative meetings; including preparation and facilitation of quarterly review meetings; in order to have a positive impact participating in external Provider Collaborative meetings.
  • Responsible for oversight of the resolution of escalated problems, including those identified by the providers, and those identified internally that have an impact on the physician. Coordinates with internal business partners to assist as appropriate, including creating project plans, issue logs, conference calls, etc.
  • Works to continually shape the Network landscape, by education to all stakeholders in the market
  • Ability to collaborate with the Contracting team to review contracts to gain understanding and communicate intent to providers.
  • Drives continuous provider education and knowledge about ConnectiCare plans and products, ensuring full understanding; Promote wholesale policy change, and develop educational programs on a routine basis.
  • Balance the interests of CCI with providers.
  • Performs other related duties and projects as assigned


Qualifications:

  • At least 3 - 5 years of previous experienced in managed care, health plan operations in provider contracting, provider relations, customer service, or claims.
  • Bachelor’s Degree required, or equivalent combination of education and experience.
  • Ability to work independently, prioritize and manage projects in a demanding, fast paced environment.
  • Strong problem-solving skills coupled with the ability to facilitate resolution to issues.
  • Understanding of health insurance products, claims payment and reimbursement methodologies. 
  • Excellent communication skills, including presentation and education, required.
  • Strong interpersonal skills required including ability to affect change in a dynamic health care environment.
  • Demonstrated proficiency in MS Office suite as well as other related software applications.

ESSENTIAL JOB FUNCTIONS:

  • Requires travel 50% of the time using own transportation.
  • Primarily sedentary.
  • Must be able to use standard office equipment.

ConnectiCare is an equal opportunity employer. M/F/D/V

ConnectiCare is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.

Job ID: 19-065
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