Apply on Employer Site

ChenMed · 4 days ago

Network Representative West Park (Cleveland)

Cleveland, OH

Full-time

Onsite

Mid Level

$59K/yr - $85K/yr

3+ years exp

ChenMed is a family-owned and physician-led company transforming healthcare for seniors. The Network Representative is responsible for establishing a Coordinated Provider List (CPL) to provide specialty care services, managing relationships with providers, and educating primary care physicians about medical cost opportunities.

Health CarePrimary and Urgent Care

Responsibilities

Has direct accountability for total medical cost and quality of care external to ChenMed within the region

Builds, refines, and manages a tiered network of coordinated external specialists and facilities to form a Coordinated Provider List (CPL) for those specialties outside of HCT and Specialty Care. Local relationship builder with all providers and payor partners in the CPL

Identifies areas to improve provider service levels and quality. Leads a quarterly meeting National Specialty Directors and Network Director to review pattern, trends, and opportunities within the CPL

Responsible for meeting with high volume community specialist at least monthly to give them feedback on their referring trends and practice patterns as it relates to part B & D

Attends center meetings such as Transforming Care Meetings for to gain feedback about the CPL and educate PCPs about medical cost opportunities

Meets with individual PCPs regularly (usually monthly or more frequently as needed to support business need) to gain feedback about the CPL and provide targeted education about medical cost opportunities (A/B/D)

Collaborates with Center Dyads to analyze, identify opportunities and support improvement initiatives within referrals including workflow, productivity, leakage and consult tracking

Coordinates utilization of CPL with Care Coordinators and Referral Managers: develops plans to reduce referral leakage

Maintains knowledge of medical trends, cost drivers and cost saving opportunities

Support communication and collaboration with health plans at the city/area and regional level

Performs other duties as assigned and modified at manager’s discretion

Qualification

Advanced business acuityHealthcare experienceMicrosoft Office SuiteProvider relationship managementFluency in EnglishOrganizational skillsTeam-oriented

Required

Advanced-level business acuity

Comprehensive knowledge and understanding of general/core job-related functions, practices, processes, procedures, techniques, and methods

Advanced skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in other systems required for the position

Ability and willingness to travel locally, regionally and/or nationally up to 80% of the time; flexible to work evening, weekends and/or holidays as needed

Team-oriented with the ability to work extremely well with patients, colleagues, physicians, and other personnel in a professional and courteous manner

Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks

Spoken and written fluency in English

This job requires use and exercise of independent judgment

BA/BS degree in Healthcare or related field is required OR additional experience above the minimum may be considered in lieu of the required education on a year-for-year basis

A minimum of 3-5 years' work experience in Healthcare or related field is required

A valid, active driver's license in State of employment is required; position may require travel within the market