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Employment Type:

Full time

Shift:

Description:

Reporting directly to the PHSO Director of Operations, the PHSO Provider Network Lead maintains and evolves MercyOne’s Partnered Provider Network (PPN) built on robust adequacy, access, and quality standards. This role serves as a liaison and key leader between PHSO administration, Chapters, Medical Staff Offices, employment offices, and MercyOne Partnered Provider organizations and their clinicians.

ESSENTIAL FUNCTIONS

1. Provider Network Management & Planning

Under the direction of the Provider Network Council, performs ongoing assessment of Partnered Providers including metrics related to access, quality, cost, and efficiency. Works with leadership to develop action plans and strategies to address network gaps and lead network growth. Under the direction of the Provider Network Council, responsible for leading the recruitment of new Partnered Providers as well as notifying existing Partnered Providers of their termination or probation from the Network for failing to maintain Network standards. Serves as a subject matter expert on network adequacy and responsible for ensuring network adequacy through population health analytics software. In collaboration with the credentialing/enrollment team, ensures appropriate business information is captured and reportable through the enrollment system. Contributes to commercial strategy development and value-based contract success under commercial payer arrangements through network opportunities, marketing and education. Oversees the preparation of reports as needed to support commercial strategy, such as payer reporting packages, Partnered Provider reporting packages, credentialing/enrollment reports, etc.

2. Network Communications & Contracting

Oversees robust tracking processes related to Network contracting with the ability to synthesize through reporting. Ensures the appropriate management of PHSO Participant Agreements, and in collaboration with the contract administrator ensures contracts are filed and retained in line with policies. In collaboration with the compliance team, investigates and responds to member inquires and complaints related to Network or Partnered Provider concerns. Represents the PHSO in payer meetings, with the ability to speak to the PHSO mission, vision, strategic priorities, and core competencies.

3. Governance Support

Reporting to the PHSO Division Director of Operations and in collaboration with the PHSO Chief Medical Officer, develops, maintains and participates in monthly Provider Network Council meetings and related governance structures. In collaboration with the quality and care management team, ensures alignment and strong communication between Provider Network Council and Clinical Integration Council. Responsible for Provider Network report-outs to the Provider Network Council and PHSO Board of Managers.

4. Supervision

Oversight of provider network team work schedules, assignments and performance appraisals. Responsible for development of an effective provider network team, including recruitment, training, coaching/mentoring and professional development planning. Responsible for ensuring compliance with MercyOne’s personnel policies.

LEADERSHIP COMPETENCIES

As a MercyOne Trinity Health Leader, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below:

Mission Statement: We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

• Reverence: We honor the sacredness and dignity of every person.

• Commitment to Those Experiencing Poverty: We stand with and serve those who are poor, especially those most vulnerable.

• Safety : We embrace a culture that prevents harm and nurtures a healing, safe environment for all.

• Justice: We foster right relationships to promote the common good, including sustainability of Earth.

• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.

• Integrity: We are faithful to those we say we are.

MINIMUM QUALIFICATIONS

Education: Bachelor’s degree required. In lieu of educational requirements previous work history and years of experience may be considered.

Experience: Minimum of two years of experience with a healthcare system, health plan or healthcare accrediting body. Prior experience in provider network management strongly preferred. Prior experience managing staff required.

Licensure or Certification: N/A

Knowledge & Skills:

Experience supervising staff required. Experience in PHSOs or ACOs and knowledge of value-based payment structures preferred. Demonstrated proficiency in Microsoft applications required. Ability to perform in-depth data analysis in Microsoft Excel preferred Knowledge and understanding of CMS network adequacy standards, and querying network adequacy utilizing population health analytics software, preferred Knowledge and understanding of payer contracts preferred Experience working with a professional Board or Council including conducting meetings preferred Strong demonstrated verbal communication and critical thinking skills required. Excellent verbal and writing skills required, as well as excellent planning and negotiating skills, required. Experience liaising with physicians and healthcare organizations preferred. Excellent project management skills required. Demonstrated presentation skills preferred. Demonstrated ability in policy development and contract management preferred. Knowledge of NCQA Accreditation Standards in Provider Network an asset.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

1. Must be able to pass a pre-employment health and drug screening at time of hire.

2. Frequently required to carry or lift items weighing up to 10 pounds. Occasionally required

to carry or lift items weighing up to 25 pounds for short distances.

3. Occasionally required to stand or walk. Frequently required to sit in a stationary position.

4. Occasionally performs activities that require stooping, bending and reaching, squatting,

balancing, and trunk twisting throughout the day.

5. Frequently able to detect and discern both loud and soft sounds such as phone calls and

customer questions.

6. Constantly able to use hands and fingers to type, write, and file. Frequently able to use

near vision for viewing computer monitor and written materials. Occasionally required to

detect unusual odors that could indicate environmental issues.

7. Must be able to travel to the various MercyOne sites as needed.

8. Must possess the ability to comply with MercyOne policies and procedures.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran