Clever Care Health Plan is one of Southern California’s fastest-growing Medicare Advantage plans, dedicated to meeting the unique needs of diverse communities. The Provider Relations Representative will manage provider relationships, assist with contracting and network development, and support various initiatives to enhance healthcare accessibility.
Responsibilities
- Manage provider relationships in assigned territories or assign areas with all types of providers, including physicians, IPAs, hospitals, ancillary services, acupuncture and other Eastern Wellness providers and health care professionals
- Provide information on Clever Care activities applicable to a particular office
- Work with internal departments as well as providers to obtain required information to facilitate Clever Care activities, including annual wellness visits (AWV), special needs plan (SNP) attestations, audit follow-up, etc
- Participate in Clever Care sales and marketing events, joint operating meetings (JOM) and other public facing activities
- Identify potential contracting opportunities amongst all types of bilingual providers; work with the Senior Manager of Community & Provider Development on the actual contracting and negotiation process, including fee-for-service (FFS) and capitation reimbursement strategies
- Identify new partnership opportunities with network providers
- Discuss co-branding to offer a wider reach to focused populations
- Develop provider affiliation announcement letters for member awareness
- Coordinate and set up health fairs and other special events
- Manage key provider relationships by being the main point of contact for providers and business staff
- Maintain existing provider partnerships – acupuncture, primary care physicians, and other alternative networks
- Contribute to the development and management of alternative network initiatives (e.g., herbal vendors)
- Support Sales and Marketing Teams on the needs of independent brokers, agencies, and field marketing organizations (FMOs)
- Establish relationships with community-based organizations such as Places of Worship, Community Health Centers, and Social Services
- Maintain effective channels of communication with all internal departments, the most frequent being Operations, Credentialing, Compliance, Sales and Marketing, and Member Services
- Other duties as assigned
Skills
- Bachelor's degree preferred
- One (1) to two (2) years of Health Care or Managed Care with Provider Contracting, Network Management or Provider Relations
- Valid driver's license, reliable transportation, and insurance required with clean driving record
- Demonstrated ability to manage multiple projects and meet deadlines
- Strong communication and presentation skills with ability to effectively communicate with all levels of the organization, internally and externally
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Ability to speak, read and write on a business level in one of the following languages preferred: Khmer, Thai, Mandarin, Cantonese, Korean, Vietnamese or Spanish
Company Overview
- Clever Care Health Plan is a healthcare company that provides health insurance for medicare services. It was founded in 2018, and is headquartered in Huntington Beach, California, USA, with a workforce of 201-500 employees. Its website is https://clevercarehealthplan.com.