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Director of Provider Relations and Process Improve

Position Summary:
The Director of Provider Relations and Process Improvement Initiatives will be responsible for management of Health Alliance's provider network, including network education, provider communications and relationships, issue resolution, and network expansion. The director will oversee network operation and performance relative to quality, financial, and growth goals. Achieving superior Provider experience and optimization of the provider portal are critical areas of focus. The Director will support strategic growth by creating and implementing strategies and programs that will put Health Alliance in the top decile for provider satisfaction and also make us a benchmark organization nationally. The Director is charged with doing a comprehensive assessment on an annual basis of all operational processes, work flows and policies and procedures and identifying categories that require process improvements. This includes but is not limited to; updating and maintaining Department policies and procedures, creating desktop resource tools, serving as the Department communication and writing expert, and implementing a Project Management Office (PMO) work plan process to recording, tracking and updating all customer request in process within PNM.The director is also responsible for supervision and development of the Provider Relations team. The director will work closely with Health Alliance's leadership team and the vice president of the Provider Network Management to support key strategic provider partnerships.


Qualifications:
EDUCATIONAL REQUIREMENTS
Bachelors Related Field or Master's degree in business, health care management, or related field preferred. Equivalent experience will be considered.

EXPERIENCE REQUIREMENTS
Ten (10) Leadership and Five (5) years of experience in provider network operations and development.

OTHER REQUIREMENTS
Must maintain broad knowledge of health care industry. Communicates and works well with people at all levels. Must be results-oriented and possess strong work ethic combined with personal and professional integrity. Requires strong interpersonal and analytical skills. Position requires high levels of problem solving and collaboration across all levels of the organization. Excellent presentation skills required. Must be able to work hours as required by position. Occasional travel required, including overnight. Able to utilize current software products as necessary.



Essential Functions:

•Directs the execution of provider operations and provider relations strategic and tactical plans to meet corporate objectives. Identifies changing trends and market demands to assist the organization in the strategic planning process. Collaborate with strategy and business development team to support key provider partnerships.
•Provider Services: Ensures provider operations function in a manner that safeguards confidential information, and adheres to Health Alliance's code of conduct and all legal and regulatory requirements. a. Oversee the department's call center/operations which serve providers and office personnel through education and issue resolution. b. Department owner of the provider/office personnel website portal and accountable for content, enhancements of the site as well as, maximizing utilization. c. Drives continuous process improvement across the provider services team to reduce waste and inefficiency.
•Provider Relations: Provides director level leadership to the Provider Relations team ensuring Health Alliance's objectives of quality, service, and cost-effective operations are achieved. a. Leads provider recruitment process ensuring members access needs are met. b. Accountability for the timeliness and accuracy of provider directories. c. Accountability for timeliness and accuracy of provider education to include but not limited to provider manuals and newsletters, and d. Implementation of providers, networks and contracts adhering to standards established by Health Alliance. Products include commercial fully- insured (including exchange products) and self-funded, Medicare Advantage.
•Interfaces with other internal departments in regards to coordinating provider activities and the coordination of credentialing and re-credentialing activities. Collaborate with quality and medical management departments to share network performance related to key quality and medical management goals.
•Chairs and/or participates in internal and external committees and workgroups as necessary.
•Assigns appropriate departmental resources as necessary to accomplish the short and long- term objectives for the provider service and provider operations.
•Serves as a resource to leadership regarding resolution of complex provider issues.
•Support transition to value-based/risk-based provider agreements, including high value networks and other strategic partnerships.
•Manage and develop provider relations services staff.
•Oversee network expansion and adequacy testing to support strategic growth and market development.
•Work collaboratively with medical leadership on administration of provider satisfaction surveys and performance.

Time:  Full time
Salary:  Salary
Category:  Network management

Updated: 4/26/2018 8:53:00 AM