Job: Provider Relations Manager - Oncology Services - NW6807EC

JOB SUMMARYNew Management level position within ICORE's Oncology Services team. Responsibilities will include developing the infrastructure and communications for this new team within the Oncology Services business unit. Additionally, developing and supporting drug pull through activities to complement the Reimbursement components of the Oncology Services program, promoting a positive perception of ICORE, developing a customer oriented, collegial partnership with the health plan's provider relations team and with providers; conducting provider education and training programs for new health plan customers and when implementing new clients, product lines and when performance issues warrant remedial focus; taking the lead in responding to and resolving provider issues; driving contract rate negotiations, either directly with the provider or in collaboration with the health plan staff; facilitating problem-solving with other internal operations stakeholders and client provider relations personnel to achieve fair resolution and positive outcomes whenever and wherever possible with providers; and/being proactive in communicating with high-impact providers in each market to ensure that the highest provider satisfaction levels are achieved and client appreciation is gained as a result. The position requires excellent oral and written communication skills and professional presentation capabilities. Pharmaceutical/drug experience desired - within the Oncology services area a plus. Travel required- up to 40%.


ESSENTIAL FUNCTIONS

Assume leadership role in researching provider complaints and issues, collaborating with personnel from various internal operations areas to determine root causes in order to remedy these problems, being on point to communicate with providers throughout the course of problem resolution.
Take the front line in establishing and maintaining strong communications with ICORE clients and their providers.
Work with ICORE's Account Management team to create a seamless relationship transition between ICORE and client Provider Relations team.
Support and potentially lead contract negotiations on behalf of health plan customers with key provider groups.
Establish and maintain optimal communication channels with ICORE client provider relations and account management personnel at the corporate and market levels to foster confidence in ICORE's abilities to rapidly resolve provider issues.
Establish and maintain an effective approach to coordinating with the provider relations and network development personnel of client's provider relations teams to collaboratively educate network participants and resolve provider issues satisfactorily in client markets.
Identify opportunities for promoting broader use of ICOREAuth and proactively communicate with providers not taking full advantage of the tool.
Understand and analyze the key oncology groups in each market and develop accessibility analysis for new and existing markets.
Build positive relationships with provider groups to establish the opportunity for future network opportunities.
Conduct telephonic, web-based and onsite training sessions (individual and group) for new network participants (rendering providers) and for ordering providers during new client implementation phases.
Conduct training sessions for clients' provider relations and call center staffs so as to equip them with the background knowledge of ICORE processes to assist in their ongoing training of their network providers.
Routinely monitor provider performance to target and perform remedial training sessions based upon area of need (e.g., authorization processes, claims submissions, etc.).
Special projects as assigned by management.

MINIMUM REQUIREMENTS

Education: BA/BS, MA/MS/MBA preferred
Experience: 3-5yrs.
Industry: Pharmaceutical/Drug experience desired
Job Specific: Three to five years in a Provider Relations role for a managed care plan or other with minimum of one year in a supervisory role. Solid knowledge of health plan operations and landscape is required.
Will accept an equivalent combination of experience and education and the education and/or experiences may run concurrent.


PREFERRED QUALIFICATIONS

Education: BA/BS in Healthcare administration or other


WORKING ENVIRONMENT

This position may include the following situations: Ability to lift up to 15 lbs.