Provider Relations Specialist - Utilization Management Admin - Sharp Copley - Day Shift - Full Time

Hours:

Shift Start Time:

8:30 PM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum- Midpoint- Maximum):

$31.700 - $39.620 - $47.540

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

The Provider Relations Specialist is responsible for the development and maintenance of positive working relationships with all partners, by collaborating on complex organizational initiatives across the integrated delivery system. Provides the connection and partnership between the subcontracted providers, subcontracted services and SRS Medical Group (SRSMG).

Required Qualifications

• H.S. Diploma or Equivalent
• 4 Years experience in the health care field with particular emphasis on physician network, physician services, and physician recruitment.
• Driver's License- CA Department of Motor Vehicles- REQUIRED

Preferred Qualifications

• Bachelor's Degree Business, marketing, or health care management.

Other Qualification Requirements

• Utilizes reliable transportation and possesses adequate personal insurance coverage. Demonstrates clean driving record in accordance with requirements of the employer DMV pull notice program and Sharp HealthCare Driver Guidelines.

Essential Functions

• Provider Relations

Primary liaison between SRSMG and health plan provider network, promoting positive relationships between the medical group and the health plans. This includes but is not limited to working with Quality Department to follow up on quality issues with providers office.

Researches and resolves incoming escalated provider inquiries within specified guidelines and educates providers on new protocols, policies, and procedures.

Ensures provider contracting policies are adhered to as related to standard contract language.

Routinely visits various locations to ensure that a good partnership is maintained and credentialing requirements and quality standards are being monitored effectively.

Maintain an understanding of basic managed care concepts and principles including Managed Care, Medicare, Commercial HMO/PPO benefit programs.

• Communication

Must be able to communicate effectively and efficiently both verbally and in writing with providers, peers, patients, and others

about day-to-day issues and concerns. Communicate with all SRS departments to keep staff informed of provider and healthcare delivery organization changes.

• Credentialing

Coordinating and ensuring the completion of necessary site visits, monitoring the quality of care being provided by the service/provider, and providing leadership with updates on any variances or trends that could impact service delivery. The role also involves compiling comprehensive summaries for the recredentialing of health care providers, ensuring all practitioners meet the required professional standard for continued affiliation with the medical group.

• Problem Solving

Provides on-going service/problem solving assistance to providers or health plans as needed and ensures all providers are updated on newly revised policies and procedures.

• Provider Data Requirements

Communicate and validate provider demographics to comply with the Health Plan's regulations and compliance with state insurance regulations.

Knowledge, Skills, and Abilities

• Requires excellent interpersonal skills, including the ability to communicate clearly and professionally, both verbally and in writing; ability to negotiate, ability to be highly flexible in situations, ability to prioritize duties.
• Must be able to make decisions to resolve issues and solve problems with minimal direction.
• Must be creative, outgoing and able to get the job done while working in a department with limited support.
• Must have organizational and analytical abilities.
• This position requires a broad understanding of physician/hospital relations, physician service programs and (HMO, EPO and PPO) plans.
• Must demonstrate professional image.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class