As part of the Shriners Hospitals for Children (SHC) Department of
Medical Affairs, the Health Plan Liaison is responsible for deployment of
governmental and commercial health plan requirements which SHC sites
participate with. The Health Plan
Liaison will provide education and tools to the physicians, advanced practice
professionals, and hospital and corporate staff regarding payor-specific
guidelines for medical necessity, utilization management, prior authorization,
quality metrics, and other requirements.
The Health Plan Liaison will exemplify the mission, vision, values and
customer service philosophy of Shriners Hospitals for Children in job
performance and in service to other persons outside of and throughout the
Develops and implements education, and training
materials to facilitate payor-specific guidelines are diffused into practice.
Monitors, interprets and deploys NCQA payor and
provider quality standards.
Facilitates regular reporting to internal
departments, hospitals and headquarters leadership as needed.
Works closely with hospital and executive
leadership, and appropriate hospital staff to expedite provider enrollment turnaround
Establishes and maintains close working
relationships with hospital credentialing coordinators, network management,
provider, other hospital/headquarter departments, and payer contacts as
and manages projects, budget and resource allocation.
Coordinates with Network Management to deploy health plans
Validates provider enrollments with health plans and coordinates
with plans to ensure provider status is published and deployed to mitigate
denials for professional fees.
Provides education with Care Management team to Optimize Health
plan resource utilization.
qualified candidate will have experience in the following areas:
Skills, and Competencies:
Well-organized, detail oriented and
able to meet deadlines with minimal errors
Strong written, phone, and verbal
communication skills; proven ability to communicate with physicians and