Network Representative-2 - ChenMed LLC : Job Details

We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.

The Network Representative is responsible for establishing a Coordinated Provider List (CPL) to provide specialty care services within specific geographic regions. This individual will report to the Network Director to develop the CPL and serve as a relationship builder with providers. They will use database systems to manage provider data and produce reports for leaders to support improved medical costs and specialty care utilization. The Network Representative will also educate our PCPs about these providers and highlight medical cost opportunities in their panels.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Accountable for total medical cost and quality of care outside ChenMed within the region.
• Builds and manages a tiered network of external specialists and facilities to form the CPL, acting as the relationship builder with providers and payor partners.
• Identifies areas for improving provider service levels and quality, leading quarterly reviews with National Specialty Directors and the Network Director.
• Meets monthly with high-volume community specialists to review trends and practice patterns related to Part B & D.
• Participates in center meetings to gather feedback about the CPL and educate PCPs on medical cost opportunities.
• Meets regularly with PCPs to gather feedback and provide education on medical costs.
• Collaborates with Center Dyads to analyze referral patterns and support improvement initiatives.
• Coordinates CPL utilization with Care Coordinators and Referral Managers to reduce referral leakage.
• Maintains knowledge of medical trends, cost drivers, and savings opportunities.
• Supports communication with health plans at various levels.
• Performs other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Advanced business acuity
• Knowledge of core job functions, practices, and processes
• Advanced skills in Microsoft Office Suite and other relevant systems
• Willingness to travel up to 80% locally, regionally, or nationally; flexible with working evenings, weekends, or holidays
• Team-oriented with excellent interpersonal skills
• Exceptional organizational skills and ability to prioritize
• Fluency in English
• Ability to exercise independent judgment

EDUCATION AND EXPERIENCE CRITERIA:

• BA/BS in Healthcare or related field, or equivalent experience
• 3-5 years' experience in Healthcare or related field
• Experience with Medicare HMO preferred
• Valid driver's license required; travel within the market may be necessary
• Experience in Medicare Managed Care preferred

We're ChenMed, transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, we focus on improving health and well-being for our populations. We're growing rapidly and seeking passionate individuals to join us.

ChenMed offers competitive pay, comprehensive benefits, career growth, and a supportive work environment. Join us and make a difference every day.

Current Employee apply HERE

Contingent Workers see job aid HERE to apply

Who We AreChenMed is a family-owned organization dedicated to providing superior healthcare to moderate-to-low-income seniors.Our visionTo positively change American healthcare through primary care innovation for the neediest populations.

Our missionTo offer a patient-centered environment that fosters enduring relationships between doctors, staff, and patients, delivering superior outcomes and compassionate care. We aim to create a healthcare system tailored to our patients' needs through dedicated doctors, a supportive team, and innovative technology, achieving value through scalability, resourcefulness, and accountability.

Our patient promiseYou are the reason we are here. Your healthcare and well-being are our focus. We will care for you like family, in good times and in times of need.