The Native American Liaison, who is a member of a federally recognized tribe, is responsible for outreach to Native American members, Indian Health Care Providers and tribal representatives. They shall serve as a resource to, and advocate for, Native American ABD members in New Mexico, and IHCPs in their interactions with the health plan. The incumbent provides service and education to tribal network physicians/providers and achieves company targets through the implementation of network improvement plans and provider satisfaction assessments. They shall ensure health outcomes of our Native American members in New Mexico are constantly improving.
Key Duties and Responsibilities:
- Advocates for Native American members with care management and member's services staff to ensure health outcomes of our Native American members in New Mexico are constantly improving.
- Plans and works with Provider Services staff to expand and enhance physical and behavioral health services for American Indian members.
- Serves as the single point of contact with tribal entities and all state customer staff on American Indian issues and concerns.
- Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information, and review HEDIS information.
- Achieves call reach and frequency goals to establish consistent and strong relationship with provider offices.
- Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.
- Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, Frequent Flier Reports and other analytics available to improve /maintain regions.
- Identifies network gaps and complete contracts or work with Network Development.
- Understands and explains risk contracts.
- Strategizes for membership growth and retention.
- Provides training, mentoring and guidance to new representatives.
- Performs other duties assigned.
This position is contingent upon the bid award in the state of New Mexico to WellCare Health Plans, Inc.
- A Bachelor's Degree in a related field or equivalent work experience required.
Candidate Work Experience
- 3 years of experience in Provider Relations or similar background required.
- 1 year of experience in Medicaid/Medicare required.
- 1 year of experience in Indian Health Services required.
- Pharmacy, Healthcare, Provider or HMO/PPO background preferred.
- Demonstrated understanding of the unique considerations regarding health care delivery within tribal communities required.
- Advanced - Ability to multi-task.
- Intermediate - Ability to communicate and make recommendations to upper management.
- Intermediate - Ability to influence internal and external constituents.
- Intermediate - Ability to work in a fast paced environment with changing priorities.
- Intermediate - Ability to work as part of a team.
- Advanced - Ability to represent the company with external constituents.
- Intermediate - Demonstrated written communication skills.
- Advanced - Demonstrated interpersonal/verbal communication skills.
- Advanced - Demonstrated customer service skills.
- Advanced - Extensive experience in establishing credibility and partnering with business leaders.
Candidate Technical Skills:
- Intermediate proficiency in Microsoft Outlook, Word and Excel required.