Provider Relations Manager

Purpose:   (One sentence summary of the job function.)

To manage the organization, development, and daily operations of physician services of a Network system.

 

This position also has compliance accountability and/or responsibility for Kaiser Permanente's policies and procedures, the Principles of Responsibility, accreditation standards (if applicable), and applicable federal, state, and local laws and regulations, as well as, proper use of Kaiser Permanente Personal Computer (PC) and applications.

 

Accountabilities: (List of 4 ? 6 primary responsibilities, not activities, in their order of importance)

? Participates in the network development and manages specific aspects of the operational infrastructure supporting the Network.

? Maintains a Provider Relations Department that is timely and effective in its response to the concerns and grievances of all physicians and their office staff.

? Develops and implements strategies and procedures to oversee provider and member relations, provider reimbursements, and financial performance.

? Provides assistance in the communication of medical management procedures, compensation models, and profiling information including re-credentialing, ongoing medical management, and provider development of Network physicians and other providers.

? Provides assistance with the routine review of Network provider activities to assure the achievement of organizational goals, including financial performance.

? Develops and implement appropriate evaluation and credentialing guidelines that will serve as the recruitment and performance parameters for Network providers.

? Provides staff support to Network management committees, including, but not limited to, peer review committees, credential, and quality assurance committees.

? Works with the Network Development Manager and with regional staff to ensure that complaints/citations against Network physicians that may be issued by peer review organizations, hospital QA/UR committees, or other governmental/regulatory entities are adequately resolved.

? Works closely with the Associate Medical Director, local physicians, and staff in developing operational processes for implementation of clinical/medical policies, including practice and referrals guidelines, peer review parameters, utilization review policies, and quality assurance activities.

? Assists in the coordination of reimbursement and measurement processes to ensure that accurate information is collected regarding financial performance, quality of care, and member satisfaction with the external provider Network.

? Assists the management team in developing strategies and procedures to monitor, analyze, and effectively manage utilization of services as related to established MAPMG/HP goals and budgets.

? Ensures that referral, claims, and related reimbursement policies are clear, concise, and unambiguous to external providers.

? Effectively coordinates the communication of important Health Plan information to external providers.

? Establishes and implements a sophisticated and physician-oriented physician services function that provides training and support to providers that emphasizes the KP difference in care management, delivery, and professional culture.

? Contributes to improving the performance of the organization by identifying opportunities to improve organization systems/processes, and implementing these improvements.

 Minimum Requirement - Relevant Years of Experience: 

? A minimum of five years progressively responsible experience in health care management is required.

? Management experience in network, IPA, or related operations is required.

? Significant experience in network design, practice management, utilization management, quality assurance, and related activities and/or group practice managed care is preferred.

? Ability to analyze problem and problem-solve using a team approach is required.

? Proven management skills, including financial management, planning, and human relations is required.

? Strong orientation toward superior provider and customer satisfaction is required.

? Strong written and oral communication skills, including public speaking and presentation skills are required.

? Effective interpersonal and conflict resolution skills are required.

 

Minimum Requirement - Education and/or Classes: 

? Master?s Degree in Health Care Administration, Business Administration, or related subject is preferred.

 



Other Important Competencies (List 6-8 from attached list, typically some from each area):

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