Job Description:
• Cultivate strong, consultative relationships with assigned risk-bearing provider networks to drive engagement and meet client needs.
• Educate and support providers in navigating UM processes, including prior authorizations, medical necessity reviews, and evidence-based care guidelines.
• Serve as a key liaison between providers and the UM team, ensuring clear communication, issue resolution, and ongoing support.
• Act as the in-market expert by managing implementation, education, and continuous engagement for referral benefits and workflows.
• Collaborate with internal teams to execute engagement plans, deliver provider education, and analyze data to identify opportunities for intervention and improvement.
• Serve as an in-market expert, build relationships with key stakeholders, and promote WellSky solutions at clinical summits, town halls, and provider meetings.
• Provide regular updates on provider engagement performance, program feedback, and market insights to internal teams and clients.
• Partner with marketing and operational teams to create educational and promotional materials supporting provider engagement efforts.
• Monitor provider performance and engagement trends, analyzing UM-related data to identify opportunities for intervention, workflow optimization, and improved patient outcomes.
• Perform other job duties as assigned.
Requirements:
• At least 4-6 years relevant work experience.
• Bachelor's Degree or equivalent work experience.
• Proven ability to engage, educate, and influence healthcare providers in a healthcare or relevant domain preferably in a UM or care management setting.
• Strong understanding of Utilization Management principles, payer-provider dynamics, and prior authorization workflows.
• Experience in provider education, network engagement, or compliance monitoring.
• Ability to analyze data to drive strategic engagement.
• Experience articulating scorecards, performance metrics, and provider outreach strategies.
• Experience in coaching and development of clinical programs to increase provider quality metrics.
Benefits:
• Excellent medical with Rx, dental, and vision benefits
• Mental Health support through EAP
• Generous paid time off, plus 13 paid holidays
• 100% vested 401(K) retirement plans
• Educational assistance up to $2500 per year