Manager of Provider Relations

MetroPlusHealthprovides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlusHealth'snetwork includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealthhas been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Manager of Provider Relations will serve as the point person for managing the day-to-day relationship between MetroPlusHealth and top level-administrators at each assigned network facility and community providers. Responsible for overall provider satisfaction regarding assigned network segment and will manage respective network support team.

Please note: All qualified applicants will be expected to report in-office twice a week in our 50 Water Street, New York, NY location.

• Act as a key resource to external providers and internal key stakeholders as it pertains to operational issues impacting assigned network segment.
• Responsible for day-to-day business activities and managing provider relationships.
• Develop and implement educational processes and pro-active solutions for payment and other provider operations requirements as well as access & availability concerns
• Reviews reports on annual provider satisfaction surveys; ensures the development of plans to improve identified areas of concern; work with other departments to develop quality assurance initiatives based on survey results.
• Ensure segment's data integrity of provider directory, web search, etc.,
• Monitor/Trend Provider calls received as well as any complaints received for responsible segment
• Develops processes to educate new and existing providers regarding their contractual responsibilities as well as policies and procedures.
• Monitor provider concerns, collaborate and consult with internal leaders and department to improve operations and resolve issues impacting provider satisfaction and payment.
• Participates in cross-functional workgroups to understand impact of plan changes and initiatives on provider network, advocating for providers as appropriate
• Ensure timely responses to regulatory agencies (i.e., NYSDOH, DFS) in response to all Provider Network regulatory and compliance issues
• Facilitate with marketing and retention department management to identify opportunities in current provider locations and cultivate them in viable prospects to increase MetroPlusHealth enrollment and retention efforts.
• Coordinate events with the community/government agency offices within assigned network
• Working collaboratively with Account Management Team, build strong partnership with provider community by cultivating open communication and ensuring Account Leads are aware of provider pain points relative to claims disputes.
• Attend Joint Operating Committee meetings and takes ownership of resolving issus with assigned hospitals, etc.
• Develops policies and procedures, process improvement initiatives
• Manage and mentor staff to ensure job functions are completed appropriately and according to priorities
• Coordinates department's efforts with those of other departments
• Performs other support activites and duties as assigned

• Bachelor's degree, preferably in health care administration, and a minimum of 5 years experience in healthcare, plan or provider operations/administration/ relations or related area.
• Master's degree in Health Administration preferred
• Strong customer service experience with proven ability to build and maintain provider relationships
• Managed care, value-based payment model, quality and population health management experience
• Knowledge of principles of business and personnel administration, management functions and support service functions and ability to direct and supervise personnel
• Proficiency with Windows-based PC systems and Microsoft Office, SharePoint
• Ability to travel to meet with Providers and their representatives

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Excellent written and communication skills; ability to deliver complex information and achieve positive results
• Energetic, goal driven leader with who can motivate and mobilize staff to achieve goals.
• Strong problem-solving capabilities
• Highly organized, detail oriented, dependable and professional individual

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