Provider Network Manager
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: The Provider Network Manager (PNM) 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 is a senior role with 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 PNM 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
- Continually assess the viability and strengths of the physician network, and identify areas of opportunity, or risk, and work with Network Development on the need to recruit and place appropriate providers into existing practices
- Advise Network Development 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 Network Development, the PNM 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 on boarding 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
Education / Experience / Other Requirements
- Bachelor’s degree in relevant field (or equivalent combination of education and experience); Master’s strongly preferred
Years of Experience:
- At least 10 years as a senior leader in a managed care and/or physician practice management environment of a similar capacity while overseeing the negotiated performance-based contracts.
- Management / supervisor experience required
- Understanding of the health care delivery setting. Experience with diverse populations a plus
- Experience working with physician practices; demonstrates an understanding of practice operations
- Strong communication skills; ability to interact with clinical care team and physicians in appropriate manner
- Demonstrated quantitative and analytical skills
- Excellent organizational capabilities and good attention to detail
- Strong sense of diplomacy and ability to work under pressure
- Must have the interpersonal skills and charisma to bring diverse constituencies and teams together in pursuit of common goals
- Demonstrates the commitment, confidence and sense of urgency necessary to achieve these goals
- Ability to work in a dual reporting (matrix) environment
- Leadership skills, ability to influence, form consensus and drive an agenda
- Ability to present information to small and, at times, large audiences of various skill levels.
- Must be able to maintain confidentiality of information
- Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary
- Ability to mentor and develop staff
- Demonstrated ability to effectively source and recruit qualified candidates
- Demonstrated understanding of medical manpower planning and the requirements of each individual market and / or specialty
- Ability to effective interview, screen and establish rapport with candidates
- Strong organizational skills to maintain large amounts of data and information on candidates, markets and the organization
This position is subject to the COVID-19 Vaccination Policy for Steward Health Care Workforce. Employees in this position will be required to provide adequate proof of vaccination for COVID-19 by an FDA-approved vaccine prior to starting work. Steward will consider requests for exemptions from this vaccine requirement on the basis of medical condition or sincerely held religious belief in accordance with applicable Federal laws.
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and masking policy is required for patient and colleague safety.
You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.