Sr. Manager, Partner Benefits - Private Health Management

About Private Health Management

Private Health Management (PHM), a clinically sophisticated healthcare navigation firm, specializes in assisting clients in obtaining the best care and outcomes when facing serious and complex medical conditions. Individuals and businesses who make health a priority rely on PHM to achieve the best of what's possible in medicine. We believe everyone should benefit from the latest science-backed insights, have access to the best diagnostics, specialists, and treatments, and receive independent guidance to make informed health decisions with confidence.

ABOUT THE ROLE

An important part of helping our clients achieve the best care possible is often understanding what resources are available to them through their employer's benefits program. As the Sr. Manager, Partner Benefits at Private Health Management, you'll serve as the crucial link connecting our Employer Partners, the medical benefits they offer to their employees, and the services PHM delivers to those employees. You'll ensure optimal alignment of our services with our employer partners and ensure our ability to deliver efficiently for our clients. You will leverage your expertise in managed care principles, deep understanding of the benefits space, and a commitment to fostering strong relationships with stakeholders. You will ensure compliance with regulatory requirements of insurance specific to employer partners and help with expansions while ensuring high-quality care for our members. Your analytical skills and effective communication will drive continuous improvement and optimize contract performance, enhancing the healthcare experience for our clients.

PRIMARY RESPONSIBILITIES

• Insurance Navigation: Guide clients in selecting appropriate insurance products.
• Verification & Eligibility: Confirm coverage and resolve discrepancies.
• Relationship Management: Build and maintain strong relationships across all stakeholders.
• Pre-Authorization: Manage timely pre-authorization for medical services.
• Client Support: Serve as the main contact for client inquiries and guidance.
• Program Development: Strengthen our process improvement and program development muscles.
• Value-Based Care: Lead on VBC frameworks, ensuring alignment with client goals to enhance patient outcomes while reducing overall healthcare costs.
• Education & Outreach: Develop materials and conduct workshops on benefits.
• Compliance Oversight: Ensure adherence to regulations and standards.
• Data Management: Maintain accurate records and generate performance reports.
• Physician Network: Develop, onboard, and help maintain records on our top tier provider network.
• Collaboration with Clinical Teams: Work with clinical teams to evaluate provider strategies.
• Benefits Coordination Liaison: Facilitate benefits for corporate clients.
• Performance Monitoring: Analyze provider metrics for improvement.
• Collaboration & Support: Coordinate with internal teams to enhance care delivery.

WHAT YOU BRING TO THE TABLE

• Educational Background: Bachelor's degree and and 7+ years of provider-facing healthcare experience, preferably with a blend of experience across benefits programs, provider relations, and healthcare administration.
• Healthcare Knowledge: Strong understanding of healthcare systems & regulations, managed care, and provider networks to effectively navigate and enhance client benefits.
• Adaptability: A highly adaptable attitude with a passion for leveraging technology and process improvement to optimize benefits coordination and provider relationships.
• Problem-Solving Skills: Self-starter mentality with strong research and problem-solving skills, capable of translating complex benefits requirements into actionable strategies.
• Communication Skills: Excellent interpersonal, written, and verbal communication skills, enabling you to build rapport and foster productive relationships with providers and corporate clients.
• Detail Orientation: Detail-oriented and organized, with the ability to manage multiple priorities while ensuring the seamless delivery of benefits services.
• Technical Proficiency: Proficient in MS Office Suite and experienced with healthcare databases or CRM systems to streamline operations and enhance provider engagement.
• Team Collaboration: Ability to work independently and collaboratively with internal teams to ensure a cohesive approach to benefits coordination and care delivery.

Read what current Team Members say about working at PHM!

COMPENSATION: The target base salary for this position is $85,000-95,000 annually.

This base salary is only a part of a total compensation package that also includes: health/dental/vision benefits, 401k with match, PTO and other benefits. Individual pay may vary from the target range as factors including market forces, experience, location, disparities in market data and other relevant business considerations may all factor into final compensation.

This is a remote role requiring that you live in one of the states where we currently have business operations: AZ, CA, CO, FL, GA, IL, IN, MA, MI, MO, NJ, NC, NM, NY, OH, OR, PA, SC, TN, TX, UT, WA.

NEXT STEPS

Private Health Management is a remote company with employees around the United States. We're committed to providing you with the best possible interview experience and opportunities to spend meaningful time getting to know our company, mission, and wonderful teammates in our fully remote interviews. If your application is selected for interviews, you'll hear from a member of our recruiting team to schedule next steps. Interviews will also include: the hiring manager, peers, and often an executive from the department. We have lots of questions for you, but we're also excited to answer your questions about us. We appreciate your help in achieving an interview process that allows us to truly know each other and welcome your feedback and requests on how we can make this a reality for yourself & future candidates.

Have a quick question about the role? Email careers@privatehealth.com or simply apply here.