Employer Sponsored Job (Free to apply to)
Clinical Manager, Quality Initiatives/Provider Engagement - Richmond, VA
The Clinical Manager, Provider Engagement develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Manager, Provider Engagement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
The hours are Mon-Fri, 8am-5pm, based from the Richmond office. There is 20% travel to provider locations in VA, MD, DE.
Once proficient in processes and systems, there is flexibility to work at home 1 - 2 days each week as determined by the Quality Director.
This Manager will lead 2 groups: Quality Improvement nurses focused on HEDIS and STAR measures, and provider facing Care Coordinators focused on expense reduction strategies.
The Clinical Manager represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence.
Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
Experience in Population Health, Health care or Managed Care with Provider Contracting, Network Management or Provider Relations experience.
Proven ability supporting quality initiatives and expense reduction
Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
Demonstrated ability to manage multiple projects and meet deadlines
Comprehensive knowledge of all Microsoft Office applications
Ability to travel as needed
Nurse Practitioner(NP) strongly preferred
Understanding of Value Based Contracting / Pay for Performance
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
Comprehensive knowledge of Medicare policies, processes and procedures
As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.
If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.
Scheduled Weekly Hours
Equal Opportunity Employer
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