Provider Network ConsultantPrimary Location: Downers Grove, IL
Additional Locations: IL-Downers Grove Apply
- Acts as the primary resource for assigned profile of larger and more complex providers (i.e. market/ regional/national, large group or hospital systems) to establish, oversee, and maintain provider risk management and positive relationships and supports high value initiative activities.
- Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets. May have limited contract negotiation responsibilities for assigned providers.
- Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners on the development of business strategy and programs to support the operational plans.
- Collaborates cross-functionally to ensure resolution of escalated issues or projects for assigned provider systems and monitors performance and adherence to scorecards and payout schedules based on established quality, growth and clinical measures.
- Educates internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, policies, and procedures.
- Meets with key providers periodically to ensure service levels are meeting expectations.
- Manages the development of agenda, validates materials, and facilitates external provider meetings.
- May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers, data reports and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
- May be responsible for provider recruitment, contracting, or re-contracting activities, or may assist and support more complex contracting and discussions.
- May provide guidance and training to less experienced team members.
- Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels.
- 4+ years' experience in business segment specific environment servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation.
- 3-5 years' experience with business segment specific policy, benefits, plan design and language.
- Working knowledge of business segment specific codes, products, and terminology.
- Bachelor’s Degree or equivalent combination of education and experience.
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