This job was posted by https://idahoworks.gov : For more information,please see: https://idahoworks.gov/jobs/2155599 Provider RelationsExecutive Lead Tricare

　　Open to Oregon, Washington, Idaho and Utah

　　Primary Job Purpose

　　Oversees the Account Management of TRICARE and CCN VA contracts acrossCambia. Acts as primary coordinator/facilitator between Cambiadepartments, Network Management Leadership in all states, and theTRICARE and CCN VA provider community by providing comprehensiveinternal and external coordination, problem identification andresolution between all parties. Manages the full provider experience forTRICARE and CCN VA providers across Cambia, including education,communication, integration into the TRICARE And CCN VA providernetworks, and rapport/engagement to build and maintain strong long-termrelationships with assigned providers. Manages cross-functional,cross-departmental relationships in support of effective providerpartnerships and maintenance of networks stability and adequacy.

　　Lead (in addition to above):

　　Supports the Director, Provider Relations, as needed and assigned.Develops and deploys internal and external training programs andactivities related to provider education and communication plans.

　　General Functions and Outcomes

　　Develops and fosters collaborative, productive and professionalexternal partnerships with key providers and internal stakeholders.Brings value and establishes credibility as a trusted advisor andresource to influence positive change while imparting a positivecompany image and professional demeanor.Documents information key to the provider relationship in thedocumentation platform. Tracks and reports performance on providerengagement and other metrics. Works with internal stakeholders toensure providers have access to reports and tools to driveperformance.Maintains detailed knowledge of contract terms and performancetargets, and educates providers and other internal stakeholders.Facilitates executive-level Joint Operating Committees withproviders to discuss performance success and roadblocks, roadmapsfor improving performance, and new collaboration opportunities.Facilitates internal and external work groups to review performancereports, identify opportunities and drive action plans to progresstowards improved outcomes for clinical quality, cost containment,improved member experience, and enhanced provider experience.Coaches provider and promotes the focused use of available resourcesand tools to improve member health outcomes through providerengagement and enablement. Monitors progress and communicatesperformance and expectations needed to result in better memberhealth outcomes and efficiencies for the provider and Cambia todrive change.Identifies and leads new initiatives that assist providers intransitioning from Fee for Service payment and using innovativepayments that promote improvements in quality, cost and memberexperience.Manages the implementation of cross functional organizationalstrategies, including utilization management, provider dataimprovements, contracting - focusing on improving the providerexperience and member experience and resolution of issues that mayimpede successful execution of strategies. Ensures provider outcomesgoals are aligned with internal strategies.Develops and facilitates education and training programs forproviders and acts as external point of reference on policies.Serves as a subject matter expert on competitive intelligenceregarding the provider landscape, network performance, , and costcontainment efforts for assigned territory and/or account(s).Supports development of innovative programs and initiatives to drivehealthcare transformation.Attends meetings externally, as assigned, with the ability torepresent the health plan\'s position on local and national providerprograms.May occasionally coordinate to resolve escalated provider claimsand/or operations issues that may involve internal and externalmeetings.Additional General Functions and Outcomes for Provider RelationsExecutive, Lead

　　Assists and supports Provider Relations staff by ensuring they arewell informed in order to support the development of strongpartnerships with providers including physicians, physician groups,hospitals, integrated delivery system, etc.Assists the Director as needed in overseeing provider relationsactivities including: resolution of complex problems and focus onprovider contract models to help improve outcomes.Provides input into provider communications and education plans andstrategy to ensure that provider offices are educated in planadministrative policies and procedures and new or changing products.Coordinates and implements activities related to strategicinitiatives. Assists in monitoring results and metrics to ensureindividual and team deliverables are met.Provides support (within and outside the organization) when theDirector of Provider Relations is unavailable.Minimum Requirements

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