Details
Posted: 08-Sep-22
Location: Portland, Oregon
Salary: Open
Overview
Manage provider lifecycle processes including network operations, clinical integration, network adequacy optimization, provider engagement strategies and provider performance management in assigned territory. Provide project leadership to ensure network related initiatives achieve stated goals and meet organizational and regulatory deliverables. Conduct in-depth analysis to monitor and measure performance of networks against established metrics and offer valuable insights that can be used for planning and efficiency improvements. Act as primary point of contact for assigned provider groups and be responsible for the end-to-end relationship ensuring knowledge of and compliance with Northwest Permanente Medicine policies and procedures while achieving the highest level of customer service.
This is a hybrid position that is a blend of working both remotely and in office. Must reside in the Northwest Service Region (Oregon or Washington).
Join our medical group
Northwest Permanente is a self-governed, physician-led, multi-specialty group of 1,500 physicians, surgeons, and clinicians, caring for 630,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.
Responsibilities
Major Responsibilities / Essential Functions
Network Development
- Partner with provider contracting, sales/marketing and care delivery to develop and expand the provider network to meet geographic and service line objectives
- Conduct network adequacy analysis and develop strategies to close gaps in assigned territory. Routinely assess provider groups and develop contingency plans. Report on network resiliency, action plans and other insights to leadership
- Identify provider trends and conducts market intelligence to understand key issues
- Provide timely reports, account analyses and industry best practices to develop effective and successful network account strategies
- Remain current and well-versed in organizational and departmental policies and procedures, and developments in products and benefits which impact contracted providers
- Maintain knowledge of policies and procedures relating to utilization management, referral process, and claim adjudication
Interoperability and Operational Efficiencies
- Responsible for all market implementation activities related to network development and clinical integration, to include but not limited to, coordination and facilitation of key provider/client meetings and deep dive working sessions
- Collaborate and coordinate with care delivery operational and physician leads, and Health Plan functional areas in the execution of all contractual or negotiated deliverables in assigned territory
- Efficiently plan and prioritize own and others' work through drafting project engagement work plans. Organize implementation activities and ensure tasks are completed within scope and budget
- Develop transition plans and associated documentation when moving from implementation to network management phase. Maintain and refresh catalog of interoperability details, clinical workflows, operational guidelines and agreements
- Identify and resolve critical barriers to agreed-upon contractual obligations and negotiated deliverables while providing succinct reporting to leadership
- Manages and helps mitigate potential provider abrasion by identifying root cause, addresses ways to resolve both internally and through provider education
- Seek ways to continuously improve process quality, effectiveness and efficiency
Provider Engagement
- Build, support, and maintain critical relationships with network and affiliated practitioners, provider groups, hospital and facility organizations to ensure practitioner satisfaction and effective participation with all KP lines of business
- Lead physician engagement strategy to cultivate key provider partner relationships to drive optimal performance
- Facilitate Joint Operating Committee (JOC) meetings with provider group leadership, and other follow-up meetings with internal departments
- Ensure that decisions from external partner meetings are appropriately documented and implemented to meet or exceed goals and expectations
Performance Management
- Partner with Northwest Permanente Analytics, Quality & Care Experience leads to identify metrics and targets for provider groups. Facilitate discussions to achieve mutual agreement with provider group. Establish reporting mechanisms and dashboards for use in JOC meetings
- Tightly manage assigned practices relative to provider performance, analyzing network's quality benchmark results, missed opportunities, cost effectiveness, marketability, stability, and accessibility
- Ensure appropriate reports are available that allow practices to better manage their member population
- Identifies outliers and works closely with other internal department in strategizing how best to be improve performance while minimizing provider abrasion
- Meets with practice leadership regularly to share performance results, identifies areas of opportunities while deepening relationships at all levels within the practice
Qualifications
Minimum Education
- Bachelor's degree in health care, business or related discipline
Minimum Work Experience
- Minimum three (3) years of health care experience with a focus in network strategy, network operations, network management, provider relations or contract design/negotiation
- Minimum three (2) years of Project Management experience
Additional Requirements
- Extensive experience developing and refining provider network processes and workforce plans in both implementation and on-going operations phases of large healthcare systems
- Extensive experience in leading and managing large complex projects in a matrix environment. Ability to operate in politically sensitive environment and navigate situations while maintaining positive relationships
- Excellent interpersonal and customer service skills required. Ability to develop and maintain positive working relationships with both internal and external stakeholders. Ability to work cooperatively, sensitively and tactfully while maintaining professionalism with all levels of staff and the general public required
- Excellent oral and written communication skills is required. Proven ability to synthesize complex and diverse information to formulate a recommendation or course of action
- Extremely organized and detail oriented with exceptional follow through skills. Strong time-management skills with ability to prioritize work to ensure highest impact changes receive the major focus
- Excellent analytical and problem-solving skills. Proficient in trend analysis and/or strong financial background
- Ability to connect with physicians. Ability to influence change to improve provider experience
- Strong proficiency in the use of current software, including spreadsheets, process mapping tools, project work plan tools, charts and graphs, and basic Microsoft applications
- Able to facilitate teams and major planning events, drive decisions and helping groups work though significant conflicts
- Knowledge and business acumen to manage a health system or large provider entity relationship
- Ability to multi-task in a fast pace environment; can adapt quickly to change
Preferred Education
- Master's degree in healthcare administration, business, finance or related field
Preferred Work Experience and Qualifications
- PMP Certification or equivalent
- Six Sigma or Lean Six Sigma Green Belt Certified
- Five (5) years healthcare experience with a focus in network strategy, network operations, network management, provider relations or contract design/negotiation
- Strong knowledge of regulatory guidelines affecting the healthcare industry
- Strong understanding of relational databases with desire to increase technical knowledge
- Strong understanding of systems that enable provider data management, network design, reimbursement models and episode analytic platforms
- Familiarity with CMS 5 Star, HEDIS, Risk Adjustment, and other Pay for Performance Programs desirab
- Working familiarity with various managed healthcare provider compensation methodologies, including but not limited to: fee-for service, capitation and various forms of risk, ASO, etc.
Equal opportunity employer
At Northwest Permanente, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente believes that equity, inclusion, and diversity among our employees are critical to our success, and we seek to recruit, develop, and retain the most talented people from a diverse candidate pool.
