Manager, Provider Relations (Term)
The First Nations Health Authority (FNHA) and its employees are committed to a proactive holistic approach to health and wellness, and to the delivery of services which are sustainable and honour the customs and traditions of First Nations communities.
The Manager, Provider Relations, leads a team with the goal to advance excellence in Health Benefits program delivery through a network of qualified, culturally safe health service providers including counsellors, opticians, dentists, pharmacists, and medical supply and equipment providers. Serves to improve clients’ access to services through an ever-expanding network of providers; ensures clients receive a standard of care which meets or exceeds industry standards in a culturally safe manner; promotes understanding of services available through Health Benefits; provides a point of coordination for provider audit activities; and, ensures that providers adhere to agreements and policies.
PRINCIPAL DUTIES AND RESPONSIBILITIES
1.Manages a registry of Health Benefits providers by establishing and overseeing the process of verification and ensuring alignment with FNHA’s eligibility requirements and standards, either directly or through a third party services provider
2.Establishes, nurtures, evaluates and manages relationships with Health Benefit providers and professional bodies to ensure quality improvement
3.Working closely with Health Benefits Operations team, investigates, provides recommendations, and/or resolves complex provider-related issues in the delivery of high-quality Health Benefits programs to clients
4.Engages in positive and on-going working relationships and builds trust in FNHA Health Benefits programs and service delivery by overseeing communication between, and establishing expectations between providers, clients and communities, as well as addressing issues and concerns between stakeholders
5.Develops, recommends, implements, and creates documentation of policies and procedures relating to provider complaints and audit, including current process and policy gap analysis, compliance reviews, and risk analysis and management
6.Engages providers and relevant stakeholders to gather feedback to identify opportunities and risks to advancing excellence in Health Benefits program delivery
7.Monitors and analyzes provider activities, trends and business practices; and, provides reports and recommendations to senior management and executives for decision making on program changes, quality improvement initiatives, and service delivery improvements
8.Oversees the promotion and communication of FNHA Health Benefits program changes to providers, including designing communication, developing materials, establishing distribution and delivery methods, and ensuring quality support to providers
9.Leads or facilitates change management processes for providers; which includes working with FNHA Health Benefits management in understanding changes to be implemented, determining education and communication plans, assessing and analyzing needs of providers in implementation of change, identifying risks and impact to providers and clients, and tracking issues and feedback for reporting to management
10.Manages the education of Health Benefit providers and professional bodies to enhance awareness and understanding of cultural safety and humility and provide services that reflect the cultures and perspectives of BC First Nations
11.Represents FNHA and FNHA’s interests to professional bodies and related stakeholders to build on partnerships through effective partnership management
12.Manages a team, including selection, coaching, training and development, performance management and other people management practices
13.Leads by example, providing guidance and mentorship to team members
14.Performs other related duties as assigned
Education & Experience
•University degree in Health, Public Administration, Business Administration, or a relevant field of study plus 8 years of related experience, or an equivalent combination of education, training, and experience.
•Working with Health Benefits and/or Health Service Providers such as credentialing, quality assurance, and/or issues management
•Experience in developing, maintaining and strengthening relationships with stakeholders to advance organization objectives
•Communications and change management experience
•Experience working with third party benefit providers
•Experience in identifying, developing and monitoring service contracts
•Experience in creating and presenting reports on a variety of topics to different audiences
•Experience in developing education and awareness tools
•Experience with audit processes and procedures
•Recent, relevant, and progressive experience managing teams
•Training and experience in advancing cultural safety and humility
•Experience working with First Nations is an asset
Knowledge and Skills
•Knowledge of current health programs and services, claims guidelines, and best practices
•Knowledge of health related programs and services within First Nations communities is an asset
•Ability to build positive relationships with both clients and service providers, at times under challenging circumstances
•Ability to work independently, collaboratively, and as part of multi-disciplinary teams in a matrix environment
•Ability to communicate effectively, both orally and in writing, translating complex concepts into easily understood and audience appropriate formats
•Physical ability to perform the duties of the position
•Awareness - Knowledge of the current First Nations health governance landscape in BC.
•Leadership - Influencing, motivating, and inspiring others through direct and indirect means to accomplish organizational objectives including people and partnership development in a manner consistent with the 7 Directives, Shared Values, and Wellness Operating Principles. Able to champion change, in partnership with others, by living the First Nations perspective of health and wellness.
•Decision making - Uses sound judgment to make good decisions based on information gathered and analyzed. Considers all pertinent facts and alternatives before deciding on the most appropriate action. Commits to the decision made.
•Problem solving - Analyzes problems by gathering and organizing all relevant information. Identifies cause and effect relationships. Comes up with appropriate solutions with minimal supervision.
•Teamwork/collaboration – Strong interpersonal skills. Interacts with people effectively. Able and willing to share and receive information. Collaborates within the group and across groups. Supports group decisions. Puts group goals ahead of own goals.
•Adaptability - Adapts to changing work environments, work priorities and organizational needs. Able to effectively deal with change and diverse people.
•Planning/Organizing – Proactively plans and organizes tasks and work responsibilities to achieve objectives. Sets priorities and schedules activities. Allocates and uses resources properly.
•Work standards - Sets and maintains high professional and performance standards. Pays close attention to detail, accuracy, quality, and ensures follow through.
•Motivation - Displays energy and enthusiasm in approaching the job. Commits to putting in additional effort. Maintains high level of productivity. Self-directed.
•Initiative - Takes action to influence events. Generates ideas for improvement, takes advantage of opportunities, suggests innovations, does more than required.
•Integrity - Shares complete and accurate information. Maintains confidentiality of highly sensitive information. Adheres to organizational policies and procedures. Meets own commitments.
•Reliability - Takes personal responsibility for job performance. Completes work in a timely and consistent manner. Sticks to commitments and reports back on status of assigned tasks.
•Communication - Strong written and oral communication skills. Expresses ideas succinctly and effectively. Organizes and delivers information appropriately. Listens actively.
•Stress tolerance - Displays emotional resilience and the ability to withstand pressure on an on-going basis. Deals with difficult situations while maintaining performance and professionalism. Seeks support from others when necessary. Uses appropriate coping techniques.