Provider Network Operations Manager

October 9, 2019
Job Type


Manage approximately 50 – 75 provider groups based on membership attributions adhering to EmblemHealth’s provider network management strategy.  Take overall responsibility for provider performance management.  Advance EmblemHealth in the provider market through a positive provider experience by furthering the goals important to practices including administrative ease, quality and risk score improvement (QIP), cost efficiency, VBP and practice management.  Represent and advance Emblem’s interests in the provider market as the preferred plan through superior customer service and execution of provider engagement strategies.  Develop and manage a high performance network and utilize various provider strategies that follow four core principles: Provider and Member Engagement, Quality/Risk Score Improvement, Administrative Efficiency and Cost Effectiveness.
  • Visit and assist providers to manage quality and risk score improvement (QIP), cost efficiency, VBP and practice management. Manage territories and evaluate network performance based on a solid business perspective.
  • Ensure appropriate reports are available that allow practices to better manage their member population (member roster, care plans, quality reports, access to population health data, etc.).
  • Communicate EmblemHealth’s benefits, policies, changes, and potential downstream effects to providers through field visits and conference calls.
  • Follow up on all provider issues, questions, inquiries and facilitate resolution.  
  • Work collaboratively with internal departments to facilitate resolution as needed.
  • Demonstrate a clear understanding of EmblemHealth’s model, its supporting systems, and how they impact provider practices.  
  • Apply critical thinking skills to solve problems with logical and analytical discipline.
  • Facilitate regular meetings with providers and other follow-up meetings with internal departments.
  • Ensure that decisions from external partner meetings are appropriately implemented to meet or exceed goals and expectations.
  • Provide timely reports, account analyses and industry best practices to develop effective and successful network account strategies. 
  • Recommend and identify new business opportunities with existing or new partners to management.
  • Identify and resolve critical bottlenecks to agreed-upon contractual obligations and negotiated deliverables while providing succinct reporting to executive leadership.
  • Collaborate and coordinate with Operations, Clinical, Finance and Sales, and other functional areas in the execution of all contractual or negotiated deliverables.
  • Performs other job-related duties as required.
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