Associate Provider Network Manager

Position Purpose: The Associate Provider Network Manager (APNM) will be responsible for Care Coordination/Retention, overall Provider/Practice performance, Provider Relations: developing and maintaining robust retention strategies for Steward Health Care Network in our existing markets and for facilitating contracting and the associated paperwork and data gathering the necessary provider data to add-on providers to existing Provider Participation Agreements (PPAs).

This role will have a tremendous opportunity to impact a successful fast-growing health care system that values innovation, creativity and results.

The incumbent will provide the leadership and expertise needed to develop and implement a tactical plan to support the strategic, operational, financial and clinical objectives of Steward Health Care Network. This responsibility will be accomplished in partnership with their direct supervisor the Regional/Executive Director of Operations, Director of Network Development, SMG Leadership and Hospital Presidents in consideration of their market’s needs along with other key internal stakeholders.

• Care coordination:
  • In collaboration with the Hospital President(s), SMG Operations and SHCN leads, leverage the hospital volume tracker, risk claims data, Athena referral data (SMG only) and other pertinent data to identify the service lines where the largest area of opportunity (and highest impact) to improve care coordination
  • Responsible for managing/updating the CC and ND trackers based on most recent committee discussions with specific collaborative action plans, milestones, goals and deadlines
  • Engage providers, share specific data points and document obstacles / needs in the care coordination tracker
  • Present obstacles / needs to the local team and work to address collaboratively then report out to the leadership team on status and if further support is needed
  • Review and report out trended performance making sure improvement is being made
• Monitors the availability of in network service gaps that need to be filled in order to keep patient care services in the Steward system and proactively manages physician and key hospital leadership relationships and brings critical issues needing attention to the SHCN and Chapter leadership team
• Monitor, evaluate and routinely report on the performance of risk provider groups, hospitals, networks and other providers against goals and targets. Identify performance issues and opportunities and recommend strategies to address. Establish best practices necessary to improve HEDIS, CAHPS, and risk adjustment accuracy.
• Collaborate with clinical, quality, and risk adjustment leaders to develop strategies and actions to improve provider group/ network performance as needed.
• Advise market leadership and Regional Network Director of providers who are at risk of leaving the network and develop plans to retain high performing provider groups.
• Serve as the provider relations manager who shall maintain and retain the network composition within a Chapter. Retention of recruited physicians is based on the ability of the APNM to manage expectations of the participating provider with expectations of the network, as well as being responsive to the concerns and issues of the candidate.
• Facilitate Chapter, POD and Board of Directors meetings within their respective Chapters.
• Support the Network Development team and Payor Enrollment of providers added to existing in-network practices, facilitate the collection of provider data and filling out Schedule A (PPA) and execution.
• Assist in management of remediation efforts by the optimization team to ensure for optimal use of the EHR systems.
• Continue ongoing efforts to build a culture of accountability and clinical excellence through strategic coordination and retention of the necessary administrative team, physicians, clinicians, and staff to achieve SHCN‘s goals and objectives.
• During the Onboarding hand-off from the Network Development team, the APNM must have the ability to convey information about the Steward Health Care Network and the Steward system to leave newly signed network providers (and staff) with a positive impression about the organization.
• Ensures that new SHCN providers are effectively supported throughout the onboarding process and acts as a central point of contact when issues arise that require escalation.
• With the guidance of the Regional Executive Director, Operations, assesses the performance improvement needs of provider practices across the Chapter and coordinates all SHCN resources on the Local Chapter Performance Team to assist Chapter providers with maximizing value delivered to all key stakeholders.
• Has knowledge on all PCPs and Specialists within assigned Chapter, including key information such as group membership, affiliations, recent performance and historically contextual elements.
• Knowledge of fraud and abuse regulations, health care reimbursement systems, third party payer guidelines, general coding practices.
• Communicates regularly through various communication methodologies, including one on one or group meetings, with local providers and their staff consistent with the key messages disseminated from the SHCN Governance Structure at the direction of the SHCN Leadership Team. Develops and provides education to provider and office staff regarding initiatives of the local chapter and SHCN including health plan updates.
• Performs other duties as requested