The Provider Relations and Contract Manager is a critical member of Fulcrum’s Network Management team. The position supports Fulcrum’s network recruitment and development initiatives and functions as a liaison between providers, the organization and its customers. Responsibilities include driving Fulcrum’s provider network expansion efforts, creating targeted recruitment collateral, performing detailed market analysis and intelligence gathering as well as maintaining network KPI reports and performance dashboards. In addition, this role will assist provider training, orientation, and coaching for performance improvement within the network. This is a hybrid position requiring an on-site presence at our Plymouth, MN, office up to three days a week. Only local candidates will be considered for this role.
ESSENTIAL FUNCTIONS:
Network Development and Recruiting
- Develop geographically competitive, broad access, stable networks that achieve Fulcrum client objectives for performance, network adequacy and accessibility of provider specialty types.
- Recruit and develop provider networks to meet on-going business and client benefit needs.
- Engage and contract with independent practitioners and provider groups to join Fulcrum network(s).
- Respond in a timely manner to provider inquiries regarding contracting requests.
- Research and help resolve provider contract and utilization management issues.
- Ensure providers have proper documentation to join and remain in the network.
- Ensure welcome packets including welcome letters, quick reference guides and countersigned contracts are sent to providers in a timely manner.
- Communicate regularly with internal and external customers regarding the status of project, with specific attention to delays, issues, or changes to the project timelines.
- Participate in the development of business strategy to achieve contract objectives.
- Adapts departmental plans and priorities to address business and operational challenges.
- Working cross functionally, design and implement recruitment strategy and supporting collateral to support Fulcrum network expansion and practitioner development initiatives.
- Maintain provider manual, policies, fee schedules, and year-end letters.
Market Intelligence and Analysis
- Provide insightful competitive intelligence to inform leadership of industry trends, market composition and best practices related to provider network expansion.
- Utilize technology tools and dashboards to track trends, generate reports and analyze expansion metrics to inform progress and support network management strategies.
- Working cross functionally, develop clinical performance metrics and create reports for business partners and clients.
- Conduct periodic audits to ensure network adequacy requirements are met and ensure compliance with applicable regulations and polices.
- Perform other related duties and projects as assigned.
REQUIRED QUALIFICATIONS: (Minimum qualifications needed for this position)
Education:
- Bachelor’s degree preferred or equivalent experience.
Knowledge and Skills:
- 3+ years of experience within health care industry handling complex network providers with accountability for business results.
- 3+ years experience in the health care industry.
- 3+years of experience in a network management-related role, such as contracting or provider services.
- Knowledge of health care, managed care, Medicare and Medicaid.
- Strong, effective communicator capable of navigating challenging conversations.
- Excellent organizational, interpersonal, presentation, facilitation, and communication skills.
- Demonstrated commitment to high professional ethical standards.
- Ability to adapt to a fast paced, continually changing business and work environment while managing multiple priorities.
- Excellent follow-through skills; self-motivated and detail-oriented.
- Strong organizational skills to manage multiple projects, issues, and priorities effectively and simultaneously, with attention to detail.
- Intermediate to Expert level proficiency in the MS Office Suite (MS Word, Excel and Outlook).
PREFERRED QUALIFICATIONS:
- Understanding of managed care, health care contracting principles, applications, and products.
- Experience in provider relations and provider network management, provider and network development.
- Demonstrated experience developing and maintaining high performing practitioner networks, ie: tiered, narrowed, value based, etc.
- Strong analytical skills to aid assessment of potential program opportunities, market expansion and evaluation of quality performance initiatives.
- Working knowledge of claims processing systems and guidelines.
- Knowledge of reimbursement strategies /methods including Medicare Resources Based Relative Values System (RBRVS) methodology.
- Demonstrated ability to lead multiple high profile projects and see them to completion.
DIRECT/INDIRECT REPORTS:
- Number of direct reports: 0
- Number of indirect reports: 0
Work Location:
- Plymouth, MN (hybrid).
Fulcrum Health, Inc.
Related jobs:
Assistant Needed for Event in Miami
An exciting opportunity is available for a reliable assistant to support an event in Miami, FL. This is a one-day role, offering a chance to gain hands-on experience in a professional environment.
Job Responsibilities:
- Provide general assistance during the event.
- Support event coordinators and ensure smooth operations.
- Perform assigned tasks efficiently and professionally.
Requirements:
- Dependable and organized individual.
- Comfortable working in a fast-paced event setting.
- Ability to follow instructions and adapt to on-the-spot changes.
Compensation:
- $18/hour for the event.
- Gain valuable experience in event support.
- Work with a professional team in a dynamic environment.
Lower & Mid Hudson Valley Film Crew Jobs
We’re seeking skilled, passionate local talent for a heartfelt short film production. This SAG project tells a touching story of female friendship, loss, and the power of a home-cooked meal. It’s a 3-day shoot requiring dedicated professionals ready to contribute their expertise.
Job Responsibilities:
- Collaborate effectively to bring a compelling story to life.
- Deliver high-quality work within your specialized role.
- Maintain professionalism and adaptability on set.
Requirements:
- Experience in your field with a strong work ethic.
- Availability for the entire 3-day shoot.
- Based in or willing to work in the Lower & Mid Hudson Valley region.
Compensation:
- Competitive pay based on role.
- Opportunity to work on an SAG production.
- Gain valuable experience and expand your network in the film industry.
Social Media Internship Opportunity
We are seeking a passionate and creative individual to join our team as a social media intern. This is a fantastic opportunity to gain hands-on experience in social and digital content creation while working with an innovative brand.
Job Responsibilities:
- Assist in managing and creating content for various social media platforms.
- Collaborate with the team to develop engaging social media campaigns.
- Monitor analytics to measure engagement and provide insights for optimization.
- Stay updated on current social media trends to ensure relevance and innovation.
Requirements:
- Strong interest in social media and digital marketing.
- Creativity and an eye for detail.
- Excellent written and verbal communication skills.
- Ability to work independently and collaboratively in a fast-paced environment.
Compensation:
- Gain valuable industry experience in a professional setting.
- Opportunity to build your portfolio and develop your skills.
Studio Head – Rushing Tap Studios
Job Description:
Rushing Tap Studios is seeking a Studio Head to lead all operations within the studio facility. This leadership role requires a dynamic individual with strong facility management and project management skills. The Studio Head will oversee multiple projects, allocate resources effectively, and manage external vendors and personnel for various productions. This is an exciting opportunity to play a key role in a fast-paced, creative environment while driving new business and ensuring the facility operates at peak performance.
Job Responsibilities:
- Lead the studio’s operations and team.
- Oversee day-to-day management of the studio facility and ongoing projects.
- Ensure the studios and related spaces are maintained in excellent condition for rental purposes.
- Manage bookings of studio spaces and equipment using studio software.
- Prepare quotations, timelines, and budgets for both studio-based and field projects.
- Promote the studio facility to attract new customers.
- Provide regular reports on studio activities.
- Build and retain client relationships, ensuring the studio grows its customer base.
Job Requirements:
- Proficient in computer usage and relevant software.
- Minimum of a few years of experience in facility management or a similar role.
- Strong organizational and time-management skills.
- A creative thinker with innovative problem-solving abilities.
- Exceptional interpersonal and communication skills.
Casting Call: Gaffer and Editor Needed for Major MLS Event in Miami
Job Description:
A major MLS event is seeking experienced crew members, specifically a gaffer and editor, for two days of work in Miami, FL. This exciting project requires professionals with reliable transportation.
Job Responsibilities:
- Gaffer: Handle lighting setups and ensure optimal visual quality during the shoot.
- Editor: Edit footage to produce high-quality final deliverables.
- Collaborate with the production team to maintain a smooth workflow.
Requirements:
- Proven experience as a gaffer or editor in professional productions.
- Reliable transportation to the Miami location.
- Submit full name, phone number, email, location, portfolio or website, and desired rate.
Compensation:
- Competitive pay based on experience and position.