Provider Relations Representative (Bilingual Korean)

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We?

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values.

Why Join Us?

We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Job Summary

This position serves as an integral member of the Provider Relations and Contracting Team and reports to the Senior Manager of Community & Provider Development. This role assists and supports day-to-day contracting, network development and provider relations activities including managing key action items and relationships, special project initiatives, and deadlines.

Functions & Job Responsibilities

• Manage provider relationships in assigned territories or assign areas with all types of providers, including physicians, IPAs, hospitals, ancillary services, acupuncture and other Eastern Wellness providers and health care professionals.
• Provide information on Clever Care activities applicable to a particular office.
• Work with internal departments as well as providers to obtain required information to facilitate Clever Care activities, including annual wellness visits (AWV), special needs plan (SNP) attestations, audit follow-up, etc.
• Participate in Clever Care sales and marketing events, joint operating meetings (JOM) and other public facing activities.
• Identify potential contracting opportunities amongst all types of bilingual providers; work with the Senior Manager of Community & Provider Development on the actual contracting and negotiation process, including fee-for-service (FFS) and capitation reimbursement strategies.
• Identify new partnership opportunities with network providers.

o Discuss co-branding to offer a wider reach to focused populations.

o Develop provider affiliation announcement letters for member awareness.

o Coordinate and set up health fairs and other special events.

• Manage key provider relationships by being the main point of contact for providers and business staff.
• Maintain existing provider partnerships - acupuncture, primary care physicians, and other alternative networks.
• Contribute to the development and management of alternative network initiatives (e.g., herbal vendors).
• Support Sales and Marketing Teams on the needs of independent brokers, agencies, and field marketing organizations (FMOs).
• Establish relationships with community-based organizations such as Places of Worship, Community Health Centers, and Social Services.
• Maintain effective channels of communication with all internal departments, the most frequent being Operations, Credentialing, Compliance, Sales and Marketing, and Member Services.
• Other duties as assigned.