UPMC Community Care Behavioral Health is seeking a full-time Provider & Community Relations Coordinator to support the Network Management Department in the Greene County area!

The Provider & Community Relations Coordinator will work daylight hours, Monday through Friday, in a flexible hybrid work structure! This role will support and attend events in the Green County area, with the remainder of work done remotely/from home! There will be some occasional office time required at the Heinz 57 Center office in Downtown Pittsburgh to acquire event supplies and for necessary departmental meetings. Additionally, there may be some events that fall outside of standard business hours/days.

The Provider & Community Relations Coordinator is responsible for developing and maintaining positive relationships with members, families, advocates, providers, and other interested stakeholders in the HealthChoices community. The Coordinator is also responsible for the implementation of Community Care's outreach, education, and prevention efforts for HealthChoices members, families, and stakeholders. This role develops outreach and education strategies and activities with the full intention of providing members and families with information and assistance that will eliminate and reduce barriers to behavioral health care services. These educational efforts support the company's goal of making high-quality, cost-effective services readily available. 

Additionally, the Coordinator will initiate and develop working relationships with external providers, managing a primary caseload of assigned providers, for whom they are the principal point of contact. This role ensures that providers are fully educated as to appropriate policies and procedures for conducting business with Community Care, and also presents comprehensive knowledge of the authorizations and claims functions, credentialing requirements, the application and contracting process, and other topics of general and specific interest to the provider.

The Coordinator represents Community Care not only to providers, but in venues concerned with community education, outreach, and prevention, and develops liaison efforts with its members, families, community stakeholders, and targeted populations.

Responsibilities:

• Attend events in assigned areas, which may fall outside of standard business hours.
• Establish excellent working relationships with a defined panel of providers.
• Understand and communicate the details of the authorization process and Community Care's procedures for delivering the authorizations to providers.
• Ensure that assigned providers have current copies of all relevant educational materials, including the billing handbook and provider manual.
• Responsible for accurate interpretation of materials to providers in a consistent fashion and for identifying and proposing solutions to problems as they arise.
• Participate in the development and delivery of provider orientation and follow-up as needed with assigned group(s).
• Develop and implement an Action Plan in response to each provider service call.
• Work as a member of the Provider Relations staff, ensuring that corrective action plans are implemented and result in complete problem resolution.
• Implement Community Care's outreach, education, and prevention efforts to HealthChoices members, families, and stakeholders.
• Develop outreach and education strategies and activities with the full intention of providing members and families with information and assistance that will eliminate and reduce barriers to behavioral healthcare services.
• Record and archive the comments, suggestions, and feedback from members, families, and community stakeholders via Community Care's advisory committees and other consumer/stakeholder feedback vehicles.
  • Use feedback and comments from these venues to assist in the development of Community Care's outreach strategy and focus for its outreach plan and service plan development.