Now Hiring - Insurance Network Account Manager in Philadelphia, PA

Why Choose Health Partners Plans?

We are an award-winning, not-for-profit health maintenance organization serving Pennsylvania residents.

We offer Medicaid, Medicare, and Childrens Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. Were also committed to boosting the health of our community through outreach, education, and events. Founded over 35 years ago, Health Partners Plans continually develops new ways to encourage better health outcomes and has received national recognition for our innovations in managed care.

We are committed to creating a community where everyone belongs, acknowledges and celebrates diversity and has opportunities to grow into their fullest potential.

Perks of HPP and why you will love it here:

• Competitive Compensation Packages including 401(k) Savings Plan with Company Match and Profit Sharing
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off
• Diversity & Inclusion commitment
• Impact on the communities we service

We are hiring a Network Account Manager to join our team remotely!

Working under minimal supervision, serve as a consultant and advisor to key network providers to ensure that they are aligned and engaged with Health Partners Plans goals and objectives (STARS, HEDIS, NCQA, etc.). Present and explain current financial, clinical and quality performance metrics, and when required, create and implement corrective action plans as required.

As the Network Account Manager, your daily duties may include

• Able to work in a constant state of alertness and safe manner
• Effectively manage assigned key providers by presenting, analyzing and explaining complex financial, clinical quality, and STARS-related data to key decision makers within providers business.
• Build relationships with providers and their staff that will allow for mutual respect and trust, and clearly demonstrate the value proposition of their business relationship with HPP.
• Provide consultative support to high volume/high profile network providers to enhance their performance on clinical and quality metrics, in order to improve the health outcomes of HPP members, as well as improve their own financial performance...
• By studying and analyzing available data, and requesting additional reporting where necessary, become familiar with each assigned providers business, including QCP performance, panel sizes, panel status, referral patterns, prescribing patterns, owner relationships, clinician make-up, etc.
• Conduct routine review of network providers clinical and financial performance and ensure that the decision makers within the providers business understand their opportunities for improvement, and cooperatively create plans to ensure progress towards improvement.
• Conduct routine review of provider rosters to ensure that all information is current and accurate.
• Lead HPP collaborative teams, to support our providers in hitting key metrics and improving their quality, which in turn increase member satisfaction and outcomes.
• Coordinate the facilitation of provider issues within other HPP departments (claims, UM, etc.), without direct involvement in those issues. Stay current on all company policies, procedures and processes as they relate to all lines of business.
• Promote and support the use of the provider portal and all other HPP electronic means of communication.
• Work closely with Network Development Specialist to recruit providers as needed to support our multiple lines of business.
• Provide input on articles for Newsletters and additional communications based on knowledge of issues in the network.
• Identify, communicate, and assist in development of process improvements that will help create efficiencies.
• Assist with all project related work and any additional job duties as assigned.

Qualifications and Skills, We Value

• 5-7 years managed care experience, preferably in provider relations.
• Prior Medicaid or Medicare experience preferred, but not required.
• Bachelors Degree or equivalent work experience in Healthcare, Business Administration or related field
• Strong working knowledge of Microsoft Office Suite
• Self motivator with the ability to work independently and as part of a team
• Ability to meet deadlines and ensure compliance with all company and regulatory requirements
• Ability to prioritize workload
• Ability to present and explain complex financial and quality-related data to both internal and external participants, and collaborate in developing corrective action plans for improvement when required.
• Effective verbal and written communication skills
• Multi tasking capabilities with high level of organization
• Excellent presentation skills
• Strong numbers aptitude with ability to present in a confident manner
• Strong analytical skills with an aptitude for identifying weak areas in need of improvement
• Ability to present self in a professional manner with confidence

HPP is a nationally recognized company for their innovations in care, Health Partners Plans is more than your average health care company and can help you achieve your career goals.