Representative, Network Management

US-IL
Req No.
2017-1759
Category
Operations
Type
Regular Full-Time

Overview

Concerto provides Network Management Services and delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. For over a decade, we have provided extraordinary outcomes for thousands of people in these underserved groups.

The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. It’s about the harmony of a patient’s care, health, and dignity.

 

Working under the direction of the Director of Network Management, the Network Management Representative will drive improvements in Healthcare Quality, Performance and Cost Reduction in our Health Plan Partner’s Provider Networks through enhanced collaboration, data sharing, root-cause analysis and problem solving.

 

The Network Management Representative will establish and manage relationships within their assigned region and provide best-in-class customer service and support.

 

Responsibilities

  • Provide information and coaching on value based care; articulate the value proposition to providers
  • Increase provider engagement on managing quality and efficiency (cost/utilization) for patients in their practice
  • Manage provider performance through education on quality measures (HEDIS, HOS, CAHPS), risk adjustment, and the associated tools available
  • Influence provider behavior to improve quality using Concerto data, tools and the associated analytics
  • Educate providers on the quality incentives available to drive quality and efficiency within their practice, while improving outcomes for patients
  • Deliver continuous feedback to providers and health systems (i.e., PHOs) leveraging performance dashboards, face-to-face meetings and telephonic outreach
  • “Close” visits with actionable agreement of participation, document next steps and have exceptional follow-up to ensure results
  • Contract with and/or manage providers across the delivery system (physicians, skilled nursing facilities, hospitals, HCBS providers) in instances where Concerto may have an incentive to do so under a value based contract

Qualifications

  • Experience with Government programs (Medicaid, Medicare and the dual demonstration program)
  • Experience with Michigan market, and knowledge of existing provider delivery systems and referral patterns
  • Knowledge of the medical, behavioral health and home and community based services components of the network
  • Ability to think through and execute on a “tiering” of the network based on quality driven measures

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