About the position
Evernorth Home-based Care, In-home Primary Care is a healthcare provider and medical services company focused on delivering comprehensive care in the patient's home to improve outcomes and reduce total healthcare costs. We are currently seeking a Provider Liaison for the Philadelphia, PA metro area. This role serves as the primary contact for providers and their staff, assisting in contract management and providing supporting analyses for network and performance optimization. The Provider Liaison will drive increased patient engagement in the program by conducting outreach to targets, which includes reaching out to individual eligible members, facilities, organizations, and more. The Provider Liaison will establish and maintain strong relationships with local and regional health providers within the assigned territory, including Primary Care Physicians (PCPs), specialists, hospitals, step-down facilities, health systems, and community-based resources. This position will provide education and referral information on Evernorth Health Services Home In-Home Primary Care services and facilitate communication between external relationships and internal clinical and operations teams. The role reports to the Market Practice Manager and involves conducting outreach to targeted physician offices to educate and guide them on the ENHB program and its delivery. Additionally, the Provider Liaison will develop and maintain positive relationships with providers and other cross-functional teams, including Health Plans, Operations, Engagement, Coding, Finance, Marketing, and ENHB providers. The coverage area for this position extends to a 45-mile radius from the market city center, and may require travel outside of the assigned region. Field-based work is required most days of the week, and a valid driver's license is necessary, with mileage reimbursement provided. The responsibilities also include creating and delivering materials to educate providers and their staff on policies and procedures, contracting, quality, coding, service line initiatives, and financial performance efficiencies. The Provider Liaison will maintain internal partnerships with medical economics, legal, compliance, claims, health services, and provider data management to operationalize contracting while meeting agreed parameters with legal counsel to mitigate risk and improve operations. Organizing and conducting operating committee meetings with providers/groups to discuss policies, financial trends, quality ratings, coding performance, and collaboration opportunities is also part of the role. The Provider Liaison will assist in analyzing monthly cost trends for the direct market, recommend solutions, and identify action plans to address provider medical cost trends. Special projects and other duties assigned by leadership may also be required.
Responsibilities
- Serve as the primary contact for providers and provider staff to assist in contract management and provide supporting analyses for network and performance optimization.
- Drive increased patient engagement in the program by conducting outreach to targets, including individual eligible members, facilities, and organizations.
- Establish and maintain strong relationships with local/regional health providers within the assigned territory, including PCPs, specialists, hospitals, and community-based resources.
- Provide education and referral information on Evernorth Health Services Home In-Home Primary Care services.
- Facilitate communication between external relationships and internal clinical/operations teams.
- Conduct outreach to targeted physician offices to educate and guide them on the ENHB program and its delivery.
- Develop and maintain positive relationships with providers and cross-functional teams, including Health Plans, Operations, and Engagement.
- Create and deliver materials to educate providers and provider staff on policies, procedures, contracting, quality, coding, and financial performance efficiencies.
- Maintain internal partnerships with medical economics, legal, compliance, claims, health services, and provider data management to operationalize contracting.
- Organize and conduct operating committee meetings with providers/groups to discuss policies, financial trends, quality ratings, and collaboration opportunities.
- Assist in the analysis of monthly cost trends for the direct market and recommend solutions to address provider medical cost trends.
- Perform special projects and other duties assigned by leadership.
Requirements
- Bachelor's degree and/or equivalent work experience of 3-5 years in Managed Care and/or Provider Contracting and/or Provider Relations required.
- Sales and customer service experience helpful.
- Knowledge of healthcare provider relations, provider network systems, contracting, and credentialing requirements.
- Knowledge of the provider onboarding process, system applications, and procedures.
- Ability and willingness to share knowledge and train, develop, and coach individuals with varying levels of experience.
- Detail-oriented with proven time management and organization skills, including the ability to engage in multiple tasks and meet deadlines.
- Act with a sense of urgency to research questions or issues brought by the team and follow up to drive resolution.
- Strong presentation, analytical, and problem-solving skills.
- Excellent communication skills - verbal, written, and presentation.
- Strong working knowledge of Microsoft Office product suite.
- Ability to learn and adapt quickly.
Nice-to-haves
- Experience in healthcare sales or marketing.
- Familiarity with healthcare regulations and compliance standards.
- Experience in a field-based role.
Benefits
- Mileage reimbursement
- Health insurance
- Smoking cessation program
