Key skills
Communication
About this role
Role Overview
- 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