Job Details

SUMMARY

This position is responsible for developing and implementing the strategic direction of the Provider Network in accordance with financial, regulatory, operational, and quality objectives of the organization which includes multiple aspects of the provider experience including contracting, education and outreach, access and availability, and data and reporting. This position is also responsible for managing growth in the provider network, maintaining strategic collaboration with providers, and overseeing provider recruitment and retention by performing the following duties.

• Develops the provider network structure and contracting strategy to be in alignment with the organization's objectives and goals.
• Develops and enhances relationships with providers and administrators at all levels of the provider community.
• Directs and oversees the provider network adequacy and capacity including required state reporting.
• Develops and executes strategies related to provider relations including outreach and education, access and availability, training, feedback, and problem solving.
• Oversees the development of provider education and outreach materials to effectively communicate the organization's policies, procedures, programs and general information to providers and their administrative staff.
• Provides oversight and direction of provider data and reporting to validate accuracy of the data.
• Develops and maintains a library of provider contract templates for multiple provider types and develops standard acceptable contract language with assistance of outside counsel as needed.
• Ensures compliance with access and availability requirements as determined by the organization's policies and state and federal regulations and guidelines.
• Meets network recruitment goals for all programs as set forth by executive management.
• Develops and maintains ongoing reporting on contract status and contract warehouse.
• Prepares and executes letter of agreements (LOAs) with noncontracted providers to ensure appropriate care is provided to members timely and cost effectively.
• Coordinates preparation of monthly meeting materials for the Provider Network Management Committee (PNMC) and schedules and leads the meetings.
• Establishes various Key Performance Indicators (KPIs) relative to provider network management and tracks and reports trends to management.
• Assists with the management of the physician onboarding process in collaboration with other internal team members to ensure the physician and/or medical groups receive the proper documentation required to be a successful participant in the Provider Network and its various programs.
• Maintains confidentiality and complies with HIPAA rules and regulations.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
• Respectfully takes direction from manager.

EDUCATION and/or EXPERIENCE

Bachelor's degree from a four-year college or university in a related field is required; and four to six years related experience and/or training.

COMPUTER SKILLS

Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.

We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan. To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.

Background Check & Drug Screen Required