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Cambia Health Solutions Provider Relations Executive in Spokane, Washington

Provider Relations Executive Must reside in WA - Teleflex Option Primary Job Purpose Manages the full provider experience for assigned providers (excluding contracting and negotiation of fee-for-service reimbursement rates and terms), including education, communication, VBA performance, vendor integration into the provider network, and rapport/engagement to build and maintain strong long-term relationships with assigned providers. Drives healthcare transformation to improve quality, cost and consumer/provider experience by working with key strategic provider partners to enable their success in Cambia\'s value-based arrangements (VBAs) and innovative initiatives as well as develop relationships and capabilities for future value-based arrangements. Manages cross-functional, cross-departmental relationships in support of effective provider partnerships and maintenance of network stability and adequacy. Responsibilities * Develops and fosters collaborative, productive and professional external partnerships with key providers and internal stakeholders. Brings value and establishes credibility as a trusted advisor and resource to influence positive change while imparting a positive company image and professional demeanor. * Documents information key to the provider relationship in the documentation platform. Tracks and reports performance on provider engagement and other metrics. Works with internal stakeholders to ensure providers have access to reports and tools to drive performance. * Maintains detailed knowledge of all value-based arrangements, including contract terms and performance targets, and educates providers and other internal stakeholders. * Facilitates executive-level Joint Operating Committees with providers to discuss performance success and roadblocks, roadmaps for improving performance, and new collaboration opportunities. * Facilitates internal and external work groups to review performance reports, identify opportunities and drive action plans to progress towards improved outcomes for clinical quality, cost containment, improved member experience, and enhanced provider experience. * Drives provider engagement in strategic health plan programs, including Medicare Advantage (MA) HMO activities, MA Quality Incentive Program with assigned provider groups, and adoption of new tools and technology. Coaches provider and promotes the focused use of available resources and tools to improve member health outcomes through provider engagement and enablement. Monitors progress and communicates performance and expectations needed to result in better member health outcomes and efficiencies for the provider and Cambia to drive change. * Identifies and leads new initiatives that assist providers in transitioning from Fee for Service payment and using innovative payments that promote improvements in quality, cost and member experience. * Manages the implementation of cross functional organizational strategies, including utilization management, provider data improvements, contracting - focusing on improving the provider experience and member experience and resolution of issues that may impede successful execution of strategies. Ensures provider outcomes goals are aligned with internal strategies. * Develops and facilitates education and training programs for providers and acts as external point of reference on policies. * Maintains extensive knowledge of clinical performance levers across all lines of business, such as care gaps, Medicare STARS, and HCC coding; works closely with clinical partner on clinical improvement opportunities. * Serves as a subject matter expert on competitive intelligence regarding the provider landscape, network performance, value-based care, and cost containment efforts for assigned territory and/or To view the full job description, click here{rel="nofollow"}