Job Description

Location: Steward Health Care Network
Posted Date: 6/14/2022

Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.

The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.

Position Purpose: Reporting to the National Director of Provider Enrollment & Credentialing, the Manager, Provider Enrollment coordinates the accurate and efficient enrollment of providers into the SHCN Network and health plan contracts.

Coordinates all operational aspects of enrolling SHCN providers into SHCN-contracted managed care health plans working closely with other SHCN Managers and network representatives. Specifically, the Manager, Provider Enrollment is responsible to:

  • Coordinate the full cycle Provider Enrollment function for SHCN, across the entire provider network
  • Develop close and collaborative working relationships with provider and PO offices to streamline the accurate submission of information to the health plans and to SHCN
  • Update salesforce: tracking providers network status, entering new providers and maintenance as required
  • Conducts ongoing audit of policies and procedures to ensure processes are being followed and make necessary updates to retired/irrelevant processes
  • Identifies opportunities for improvements in the process and develops strategies to implement appropriate changes/enhancements
  • Develop partnerships with relevant staff at the health plans in coordinating enrollment of SHCN providers; independently troubleshooting issues as they arise
  • Ensure that SHCN has an accurate and up-to-date listing of all employed and SHCN affiliated physicians at all times and that each of the contracted health plans does as well
  • Work closely with SHCN, its affiliates, and the health plans to reconcile any differences in listings of enrolled SHCN physicians. Coordinates these efforts with and through the PO offices and SMG Provider Enrollment and works with SHCN Analytic Team to implement changes in provider data
  • Coordinate with the Director, Credentialing & Provider Enrollment on operational improvements and developing of new processes and procedures
  • Collaborate with SMG to align Enrollment processes and develop best practice guides that integrate teams accordingly
  • Monitor Salesforce system enhancement initiatives and conduct program testing for Provider Enrollment
  • Perform other functions as assigned

Education / Experience / Other Requirements

Education:

  • Bachelor’s degree in relevant field required or equivalent experience

Years of Experience:

  • 5-7 years of relevant experience in provider relations/enrollment function

Specialized Knowledge:

  • Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan provider enrollment and credentialing preferred
  • Excellent organizational skills, proven project management expertise
  • Strong verbal and written communication skills
  • Outstanding interpersonal skills; able to quickly establish a trusting rapport with individuals at all levels
  • Requisite poise, judgment, and trustworthiness to represent SHCN to internal and external groups
  • Maintains information in a confidential manner according to policy

This position is subject to the COVID-19 Vaccination Policy for Steward Health Care Workforce. Employees in this position will be required to provide adequate proof of vaccination for COVID-19 by an FDA-approved vaccine prior to starting work. Steward will consider requests for exemptions from this vaccine requirement on the basis of medical condition or sincerely held religious belief in accordance with applicable Federal laws.

Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.


Additional Information

Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.

Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:

  1. Any COVID-19 related care takes place in designated areas away from other patients and their families.
  2. A stringent cleaning policy has been implemented throughout our facilities.
  3. A strictly controlled visitor and masking policy is required for patient and colleague safety.

You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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