Job Description
Harris, Rothenberg International, LLC (HRI) is a global performance management firm based in New York City. HRI provides integrated solutions including: Employee Assistance Programs, Work/Life Services, Executive Coaching, Training, Organizational Development, Consulting, and Web Development. HRI assists organizations in solving their most challenging and complex people issues and works to remove the barriers that prevent organizations and employees from achieving their best.
HRI is seeking to fill a provider Network Manager position to manage our EAP affiliate provider network and support all key functions related to the network.
Oversight and management of Harris, Rothenberg International’s (HRI) EAP provider network, including:
• Management of network, credentialing, operations, and quality assurance/improvement processes.
• Development and oversight of HRI network operations plan and standards, and day-to-day fulfillment of key network operations functions to support seamless, smooth operation of the provider network.
• Provision of education and training of provider network to ensure knowledge and compliance with HRI requirements and operational standards.
• Incorporation and demonstration of HRI values for both internal and external customers. These include: being prepared, listening, knowing oneself, being honest, embracing change, emphasizing the positive, being responsive, keeping promises, valuing differences and exceeding expectations. Principle Roles & Responsibilities: Credentialing, Contracting & Provider Development
Credentialing, Contracting and Provider Development
• Manages provider credentialing process and serves as key liaison with HRI’s credentialing vendor.
• Ensures quality of EAP providers in line with HRI credentialing standards.
• Delineates adequacy of provider coverage to strategically meet current activity and new business. Identifies network gaps and oversees selection process, affiliate contracting, education and integration of providers into network.
• Reviews provider applications and supporting material which indicate past or present litigation or disciplinary action, or require second opinion, and makes recommendations for approval.
• Screens and secures ad-hoc providers in areas where HRI does not have providers, negotiates rates and executes single case agreements.
• Screens, secures and schedules qualified providers within network for onsite client visibility engagements including employee orientations and health/benefit fairs.
• Coordinates provider termination process.
Provider Relations, Education, QA, Training & Troubleshooting
• Creates, maintains and updates network policies, procedures, agreements, operational standards and provider manuals.
• Responds to general and case specific provider questions and provides consultation on network expectations, standards and procedures per HRI Affiliate Agreement.
• Develops provider communications and educational material, including for HRI provider web site.
• Manages provider complaint process; troubleshoots, documents, tracks and resolves provider issues and client service concerns.
Forms/Claims
• Manages claim and case form QA process to support timely, accurate submission of authorized services.
• Supports Finance department in troubleshooting and remediating claim and case forms that can’t be processed due to errors, insufficient information, lack of authorization, late submission or other issues.
Data
• Maintains overall responsibility for HRI’s affiliate provider database.
• Liaisons with IT regarding report creation and data needs for provider network.
• Oversees data conversions from current to new database system and oversees ongoing migrations required to maintain updated provider information.
Other
• Manages administrative processes related to network operations.
• Serves as liaison to EAP organizations that contract with HRI for network services.
• Supports HRI staff and departments, particularly EAP, Marketing, Account Management and QM on needs, requests, questions and concerns related to HRI’s provider network, including RFPs and implementation of new accounts.
• Participates in weekly EAP clinical meetings and other team meetings as required.
• Participates in special projects as required.
Job Requirements
• Minimum of a bachelors degree
• Advanced degree, CEAP and/or CPCS preferred
• Minimum of 3 years related work experience in EAP, health care, mental health or social service setting
• Ability to work independently
• A strong customer service focus
• Strong organizational, prioritization and decision making skills • Excellent written, verbal, interpersonal and teamwork skills
• Ability to exercise good judgment especially on sensitive and highly confidential matters
• Computer proficiency, including Microsoft Office notably Excel, and ability to learn new programs
To apply:
Email:
Cover letter and resume to:
[Click Here to Email Your Resumé] and be sure to include "MB - regarding Provider Network Manager position" in the subject line.
or
Mail:
Cover letter and resume to:
MB - regarding Provider Network Manager position
Harris Rothenberg International LLC
99 Wall Street
New York NY 10005
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