Manager Provider Relations

Job ID: J118272
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

I.    GENERAL OVERVIEW:  
This section contains a synopsis of the main purpose(s) or functions(s) of the job, indicating what is done.  This information will be used to develop the position posting. 
Manage team of staff in servicing health systems and large providers.  Work closely with other areas to resolve provider servicing and contracting issues.  Provide daily oversight of staff responsible for updating and maintaining practice files in systems as well as the dissemination of practice changes to appropriate departments.

 
II.    ESSENTIAL RESPONSIBILITIES:  
This section lists the major duties and responsibilities of the position.  This is not an exhaustive list of all job duties/functions/attributes.  Depending on Role, essential responsibilities may also include oversight and management of people and functions described below.
1.    Manage team of provider relations representatives and support staff in servicing health systems and large providers.
2.    Provide information to management regarding identified procedural, operational and contractual improvements.
3.    Provide daily oversight of staff responsible for updating and maintaining practice files in applicable systems and providing timely dissemination of practice changes to the appropriate departments.
4.    Support internal customer requests.
5.    Work closely with other areas to resolve provider service and contracting issues.  
6.    Represent the department in workgroups and committees that address both internal and external customer concerns.  
7.    Oversee and coordinate all training and mentoring activities for new and existing departmental staff.
8.    Other duties as assigned or requested.


III. QUALIFICATIONS:
Education, Licenses/Certifications, and Experience (For Experience requirements please see appropriate role/level guide.  If not applicable, list experience requirements below.)

Describe in objective and non-comparative terms the minimum education level, previous experience, specific knowledge skills and abilities the individual must have to perform the job.    

Minimum

  • High School Diploma / GED
  • Bachelor’s degree or four (4) years experience in managed care or insurance industry or provider relations working with hospitals and physicians
  • Two (2) or more years Management, Supervisory, Lead experience; or equivalent experience of four (4) years Management or Supervision of a subcontracted vendor relationship or similar project/relationship management
     

Preferred

  • Master’s  degree

Knowledge, Skills and Abilities

  • Strong organizational, analytical and interpersonal skills.
  • Excellent writing skills
  • Working knowledge of managed care
  • Ability to act as a change agent.

IV. SCOPE OF RESPONSIBILITY  (People Management Responsibility)
Does this role supervise/manage other employees?          No  □     Yes   x         
If yes, indicate the number of direct reports:  


V. WORK ENVIRONMENT
Most company positions are performed in a normal office environment.   Please use this section to describe unusual work conditions, such as exposure to high noise levels, temperature extremes, etc.  If “none, “please indicate with “Not Applicable.”
Is Travel Required?
No   □    Yes   □          
Unusual Working  Conditions

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job requires the ability to work as a team member.  Additionally, this job requires the willingness and ability to report to work on a regular and timely basis and may require irregular work hours, holidays and/or weekends.
 

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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