HSCSN Sr Mgr Provider Relation

The Sr. Manager, Provider Relations develops and leads HSCSN's Provider Relations program. This includes the development and implementation of provider education and training of HSCSN contract requirements, oversight of provider clinical and administrative performance, as well as overall network management activities that ensure optimal care delivery to enrollees. The Sr. Manager, Provider Relations manages the Provider Relations Team and engagement strategies that support effective Provider/Health Plan partnerships. The Sr. Manager ensures that the Provider Relations team operates as the liaison between HSCSN and the Provider Network and appropriately engages with external provider stakeholders and internal stakeholders (i.e., Finance, Claims, Quality, Customer Care and Compliance) to mitigate or resolve provider issues or concerns. The Sr. Manager, Provider Relations serves as the key Provider Relations liaison with the District of Columbia Department of Health Care Finance (DHCF) and collaborates with providers, internal stakeholders, and regulatory partners to a achieve high level of compliance and enrollee/provider satisfaction.

Minimum Education

Bachelor's Degree Business, Health Care Management, Health Care Administration (Preferred)

High School Diploma or GED General Studies (Required)

Minimum Work Experience

• 5 years related experience in managed care and/or care management. (Required)
• 5 years progressive supervisory experience. (Required)
• 5 years Prior experience in a health plan, managed care organization, medical group physician office or IPA setting (Required)

Required Skills/Knowledge

• Understanding of Medicaid benefits.
• Excellent verbal and written communication skills.
• Familiarity with computer systems and applications. Computer literate in Microsoft suite
• Strong organizational skills.
• Ability to interpret and apply departmental requirements.
• Ability to make sound decisions and use good judgment.
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service.
• Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practice.

Job Functions

Essential job duties

• Manage and improve network management operations to achieve or exceed performance standards/budgets.
• Lead the development and execution of provider network business plans, strategies and goals.
• Provide leadership and guidance to the Provider Relations, including hiring, developing, training, and retaining high-quality, productive employees.
• Serve as a resource for Health Plan expansion strategies beyond the Washington, DC market.
• Serve as a Provider Advocate within HSCSN.
• Manage the provider portal.
• Serves as single-point-of-contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract. reimbursement, practice and network profitability, ACOs and other HCP initiatives, as applicable.
• Responds timely (within one business day) to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly through to resolution.
• Is proactive in identifying issues and determining root cause so that they can be resolved timely and completely. Escalates certain issues as appropriate to leadership.
• Build collaborative relationships with physicians and their office staff.
• Represent HSCSN at community and other provider meetings.
• Serve as point of contact for all Department of Healthcare Finance communications and initiatives.

Other job duties

• May perform other duties in addition to those outlined in this job description.

The disclosed salary range includes the minimum and maximum rates within which Children’s National believes an individual’s base pay rate will fall for this position. It is not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children’s National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual’s combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children’s National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible.

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The “Know Your Rights” poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster.

Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.