Provider Network Liaison - Central, PA

Purpose: UPMC Health Plan is seeking a Provider Network Liaison to serve as the primary relationship manager and trusted partner for assigned physician practices, specialty providers, and hospital systems throughout Central Pennsylvania. In this highly visible role, you will act as the single point of contact for provider groups, helping them navigate operational needs while driving quality improvement initiatives, value-based care programs, and performance outcomes.

You'll collaborate with physicians, practice administrators, office staff, and health plan leaders to implement strategies that improve quality measures, enhance patient outcomes, and support provider success. This job is directly responsible for managing relationships with assigned hospital system and physician (primary care and specialty) partners. Relationship management for these entities should include becoming the main point of contact between the assigned entities and UPMC Health Plan.

For those in a value-based arrangement, this role is also responsible for implementing the value creation strategy for each of the primary care provider groups, specialist groups and facilities (Partners) enrolled in the UPMC Health Plan's Value-based Reimbursement program. In this role, the Provider Network Liaison works directly with providers, office staff, and hospital leadership to support them in activities that will allow for Partners to achieve clinical, quality, and financial performance goals and/or ROI targets identified for the Partner's member population.

This role also has subject matter expertise in continuous quality improvement and can work with providers and their office staff to identify and design new processes and practice workflows that will enable the transformation of care delivery to better support Partners in achieving their goals. The this role will work with a broad spectrum of UPMC Health Plan personnel, network providers, and external resources to complete all tasks related to network management projects, goals and objectives.

Some tasks will be focused on network issues related to claims payment, network configuration, or other related areas. The individual in this role must be able to work collaboratively in a matrixed environment, have strong interpersonal skills, be organized and self-directed, and enthusiastically represent the Organization and its mission and goals. This is a hybrid role and requires 3 days onsite at our Camp Hill, PA location.

This role will also travel to provider offices in Central, PA as needed (mileage reimbursed).

Serves as the on-site quality improvement and best practices champion for bringing together various UPMC Health Plan field-based efforts into a coordinated on-the-ground approach that supports Partners in achieving goals in quality-focused programs. Works with the UPMC Health Plan internal team to identify and develop specific performance improvement strategies that will support a given Partner to achieve performance goals.

Collaboratively works with the Partner to implement performance improvement strategies in conjunction with the UPMC Health Plan internal team. Manages all the information necessary to track progress on the Partner-specific value-based reimbursement strategic plan, where applicable. Distributes provider reports, leads development and implementation of action plans.

Works with the Partner to assess current state and facilitates workflow redesign to help the Partner implement best practices, better incorporate data-driven insights, and/or use the right tools to help the Partner achieve performance goals. Uses continuous quality improvement methodologies to facilitate improvement and change. Serves as the on-the-ground subject matter for quality (Medicare STARS, HEDIS) and supports practices with this knowledge and expertise.

Works collaboratively with the internal UPMC Health Plan quality team to translate quality insights into best practices. Provides assistance to the Partners and their office staff in the use of user interfaces, population health management and/or quality tools supported by UPMC Health Plan. Provides assistance and support to assigned physician practices enabling them to resolve daily operational issues including claims and network-related inquiries.

Triages requests to the appropriate internal UPMC Health Plan teams, when necessary. Bachelors degree in a business or healthcare field. Masters degree preferred.

Demonstrated experience working in clinical settings with 5 years of experience in managed care and/or physician practice management required. Experience with Medicare STARS, Medicaid HEDIS, and population health management desired. Excellent written and verbal communication skills is required.

Ability to continuously interact effectively with all Health Plan departments is critical. Experience in network performance management and/or continuous quality improvement is a plus. UPMC is an Equal Opportunity Employer/Disability/Veteran