Description:
Lead the development and managing of iCare’s provider contracts where the provider group is sub-capitated (sub-cap). The role reports to the head of Provider Relations. The person will review incoming membership files for the health plans, and then be the framework defined assign those members, on a monthly or weekly basis, to the underlying provider group. This has direct financial cost for iCare and revenue for the practices. This role is expected to work fairly autonomously, with a strong relationship internally with finance. Also responsible for relationship management with assigned provider group(s) and staff, as well as educating with provider group on initiatives that benefit the customer, provider, and health plan.
Requirements:
Essential Functions
Manage sub-cap network arrangements for sub-cap business for Optometry and Ophthalmology for both internal and external contracts in all geographies
Execute against assignments on a monthly basis ensuring updated sub-cap network enrollment based on network capacity
Participate in the reconciliation of sub-cap enrollment versus sub-cap payment revenue cycle management process as the sub-cap subject matter expert
Responsible for the general oversight of capitated provider network, to include provider data accuracy, trend analysis, and provider engagement.
Develops and maintain relationships with providers, practice managers, and care coordination teams with health system/large clinic partners within the capitated network to drive optimal performance on STARS, coding, utilization, and overall financial performance.
Collaborate with leadership on review of monthly utilization and patient access with capitated network.
Work directly with Health plan to manage Change of Assignment process.
Responsible for processing escalated inquiries from Health plan.
Participate with Department Leadership in monthly financials.
Requirements
Job Specifications
Typically has the following skills or abilities:
Bachelor’s degree in related field or equivalent experience
Minimum two years experience in provider relations or managed care
Experience with capitated providers and utilization management in a capped setting
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The compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding iCare benefits, please click here.