The Provider and Network Representative are responsible for initiating and managing the relationships between Bright Health Care or its affiliates and care partners and or providers who are contracted directly or through group contracts. This position is responsible for assuring accurate data is shared between the health plan, groups, and providers. The goals of the relationship are to support the relationship in a comprehensive manner that supports and provides effective monitoring, training, education, and performance of each care partner or provider. The Provider Relations Representative acts as the liaison communicating policies and procedures, assisting the Provider with data management, contracting, and all Health plan programs that support, growth, member satisfaction, and quality/utilization management. The position requires that the representative can efficiently and effectively assess the needs of the care partners or providers and implement plans for improvement to resolve any unmet needs. Representatives must possess excellent communication and problem-solving skills along with an extensive knowledge of managed care.

This position requires the full understanding and active participation in fulfilling the mission of BHC. It is expected that employees demonstrate behavior consistent with the core values of BHC. Employees are also expected to support all organizational expectations including, but not limited to: Customer Service, Patient's Rights, Confidentiality of Information, Standards of Conduct, and BHC initiatives.

Candidates should:

• Possesses experience in and a working knowledge of Managed care plans and programs
• Conducts training and education to care partners and providers on Operational and Utilization Management information
• Conducts direct Provider Orientations and Training on data management systems, website navigation, and SFTP setup & navigation
• Conducts site visits to service providers, resolves issues, educates staff/providers on policies, programs, initiatives, HEDIS information, and STAR initiatives as well as a variety of specialized health management services provided by BHC.
• Establishes and maintains consistent and strong relationships with provider offices.
• Represent BHC's network knowledgeably and respectfully.
• Assess the changing needs of a particular service area, identifies network gaps, and complete contracts or work with Network Development.
• Provide oversight on inquiries and claims issues and follow up with providers to ensure problems have been resolved.
• Assist with organizational and operational strategies to better service the Providers.
• Special projects as assigned or directed.

Qualifications/ Education/Training Experience

• Bachelor's Degree or equivalent experience preferred
• Minimum two years experience in managed care or other relevant experience
• Superior organizational skills and the ability to handle multiple tasks simultaneously
• Excellent interpersonal and communication skills, oral and written, with strong presentation skills.
• Excellent PC and spreadsheet skills
• A valid driver's license and car insurance

For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant's education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $55,302.65-$82,953.98 Annually.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; up to 21 days of PTO, 10 paid holidays, plus 2 floating holidays per year; and a lifestyle spending account.

This position is 100% remote but based in greater Fresno, CA. 10% travel required around Central California. Local candidates only.