ABOUT THIS ROLE

Our Markets Team is responsible for assuring the success of Bright Health in matrixed partnership with other Bright Health leaders. The Market Manager shares accountability with Bright Health’s line of business, clinical, quality and growth teams to collectively drive performance in our health plans in each market.

The Associate Market Manager has primary accountability for local market provider relations and responsibility for collaborating with other Bright Health leaders to:

• Manage the strategic partnerships with our Care Partners and top network providers;

• Manage the network performance to deliver affordable, high quality health care;

• Assure the growth and vitality of Bright Health’s insurance products.

The role impacts Care Partners and key provider awareness, satisfaction, partnership and clinical effectiveness by ensuring we have a successful approach to supporting the development and implementation of Care Partner/Bright Health quality and clinical programs, panel and attribution growth initiatives and advancing Care Partner primary care delivery models. The role performs local market provider relations and collaborates closely with Bright Health’s internal clinical, analytic and growth teams, as well as our Care Partners and top provider practices, while overseeing a team that is the face of in your market.

ROLE RESPONSIBILITIES

  • Successfully execute Bright’s Care Partner and Network provider partnerships and performance within your assigned territory.
  • Provider Relations: Lead and execute Provider Education and Network Management activities
  • Proactive research and resolution of provider issues including but not limited to claims submission, processing, and payment; contracting details; provider tools; and UM and other protocols
  • Ongoing, professional, and effective touch points with all active providers in Bright’s network
  • Lead negotiation and execution of additions and renewals of provider contracts to ensure network adequacy
  • Own maintenance of contract management system for assigned provider contracts
  • Network partnership: Contribute to developing the local network strategy including network development, provider contracting, engagement, renewal
  • Partner with Health Optimization and Bright Implementation Team to implement programs to maintain positive relationships between the health plan, physicians, hospitals, and practice managers
  • Network performance: Work closely with the Care Partners and providers in the Markets on day-to-day health plan operations
  • Work closely with Care Partners and providers with Bright Health Achieve MCR and quality targets
  • Growth: Work with Line of Business teams on new market entry execution, including product launches and market expansions.
  • Support the sales team and regional market leadership to execute distribution and sales initiatives to drive high revenue and membership targets 6. Work closely with the DOI and Bright Health legal team to ensure compliance
  • Other duties and responsibilities as assigned

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s Degree in business, economics, healthcare administration, or a related field is required.
  • Five (5) or more years of experience in healthcare, ideally inside provider and payer settings, with knowledge of managed care, network development, or network management
  • Local market knowledge of the healthcare payer and/or provider landscape
  • Project management experience.
  • Sufficient familiarity with Individual, Commercial and Medicare products to contribute to development and execution of growth and distribution initiatives.
  • Experience working with clinical, sales, and product teams to implement programs to maintain positive relationships between the health plan, physicians, hospitals, and practice managers.

PROFESSIONAL COMPETENCIES

  • Ability to work effectively in a matrixed environment and comfort with shared accountability:
  • Strong relationship skills within the healthcare provider space
  • Demonstrated ability to serve in a customer (provider) facing role and collaborative and relationship-driven style in building effective data transmissions between entities
  • Collaboration skills to effectively work with the sales team in executing on high revenue and membership targets,
  • Collaboration skills to partner closely with other Bright Health leaders to implement programs to maintain positive relationships between the health plan, physicians, hospitals, and practice managers.
  • Results oriented, capable of executing initiatives that drive outcomes.




Provider Relations


27 days ago - source

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