Network Representative- Detroit MI

Network Representative

We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.

The Network Representative is responsible for establishing and maturing collaborative relationships with the preferred specialists to whom we refer our patients and ensuring external referrals adhere to this network.

The Network Representative engages preferred specialists as the market's point of contact and coordinates among the specialists and our clinical, operations, and Referrals teams. This person will understand drivers of specialist behaviors and translates these into actions improving patient care and collaboration while reducing medical costs.

The Network Representative is also the main market Network liaison for operations, clinical, Referrals, Hospital and Community Care Team, Specialty and Medical Centers of Excellence, and Health Economics teams. This role works with the Network Director to develop strategies and tactics for strengthening existing specialist relationships, identifying key opportunities for new providers to join the preferred network, and managing poorly performing specialists out of the preferred network.

The Network Representative will leverage resources including referrals, claims, and medical cost data and qualitative market intelligence yielding key insights to optimize patient outcomes, simplify care complexity, and reduce costs of care through a robust, high-performing preferred specialist network. Preferred provider network knowledge and insights will be used to educate clinical, Referrals, and operations teams about the preferred network, referrals adherence, and medical cost opportunities and outliers.

Essential Job Duties/Responsibilities:

• Curation and management of the preferred specialty provider network in consultation with internal stakeholders
• Building relationships with preferred specialty providers to drive their behaviors and gaining mutually beneficial commitments to progress specialist relationships through the maturity framework
• Frequent rounding with preferred specialty providers leveraging analytics resources to inform about shared goals, collaboration, communication, referrals, medical cost performance, and levels of service
• Direct accountability for referrals adherence to the preferred specialty provider network
• Communication and education with clinical, operations, Referrals, and Specialty and Medical Centers COEs about the specialty network
• Collaboration with Health Econ and Specialty and Medical COEs to analyze medical cost opportunities for interventions within the Network scope
• Participate in Center clinical and operational meetings, e.g., Transforming Care Meetings (TCMs), to gain specialist network feedback and provide Network and medical costs education
• Drive preferred specialist network adherence by collaborating with Center Dyads and Referrals to analyze, identify opportunities and support improvement initiatives within Referrals including workflow, productivity, leakage and consult tracking
• Proactively and independently manage specialist network plans of action, analytics needs, and rounding schedules
• Agility to adapt strategies and tactics to changing market and company dynamics
• Examine obstacles from various perspectives to develop new and creative solutions when other attempts fail
• Strong communication and presentation skills
• Support communication and collaboration with health plans at the city/area and regional levels
• Performs other duties as assigned and modified at the Network Director's discretion

Knowledge, Skills and Abilities:

• Advanced-level business acuity
• Comprehensive knowledge and understanding of general/core job-related functions, practices, processes, procedures, techniques, and methods
• Advanced skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in other systems required for the position
• Ability and willingness to travel locally, regionally and/or nationally up to 80% of the time; flexible to work evening, weekends and/or holidays as needed
• Team-oriented with the ability to work extremely well with patients, colleagues, physicians, and other personnel in a professional and courteous manner
• Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks
• Spoken and written fluency in English
• This job requires use and exercise of independent judgment

Education and Experience Criteria:

• BA/BS degree in Healthcare or related field is required OR additional experience above the minimum may be considered in lieu of the required education on a year-for-year basis
• A minimum of 3-5 years' work experience in Healthcare or related field is required
• Healthcare experience within the Medicare HMO population is a plus
• A valid, active driver's license in State of employment is required; position may require travel within the market
• Prior experience working in a Medicare Managed Care environment preferred

We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care.

ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day.