Provider Services Director

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 377,000 members in Santa Cruz, Monterey and Merced counties.

The Alliance works in partnership with our contracted providers to promote prevention, early detection and effective treatment, and improve access to quality health care for those we serve. This results in the delivery of innovative community-based health care services, better medical outcomes and cost savings.

We are 500-ish employees who are all working towards our vision of Healthy People, Healthy Communities by living out our values of Equity, Integrity, Improvement and Collaboration in the pursuit of our mission of accessible, quality health care guided by local innovation.
We have an opportunity to join the Alliance as the Provider Services Director, leading the Provider Services Department. This role can be filled in any Alliance office: Merced, Salinas or Scotts Valley, California.

WHAT YOU’LL BE RESPONSIBLE FOR
Reporting to the Chief Operating Officer, you will:
• Direct strategic planning for the Provider Services Department, including fiscal and operational functions
• Direct development, maintenance and education of the Alliance provider network
• Direct provider contracting, including maintenance of agreements and negotiation of contracts in coordination with Alliance staff and attorneys
• Direct provider credentialing and provider data configuration activities
• Oversee strategic development implementation of new programs and services as they relates to Provider Services, including new lines of business and special projects
• Direct, manage and supervise Provider Services staff

LEADERSHIP OF:
The Provider Services Director has strategic management of the following teams and their respective functions:
• Provider Contracts
• Provider Credentialing and Data Configuration
• Provider Quality and Network Development
• Provider Relations

THE IDEAL CANDIDATE
• You possess deep knowledge of Medi-Cal Managed Care and have the ability to read, understand, and interpret regulations and adjust operations accordingly
• You are flexible and adaptable and can shift priorities with comfort and ease
• You can think on your feet, connect dots and get up to speed easily with minimal information
• You demonstrate sound judgment in discerning what needs to be escalated to someone above you
• You build relationships across all departments and help influence and facilitate change management throughout the organization to achieve shared goals
• You are committed to team development, with an ability to lead and inspire others in an environment that supports professional growth, embraces complex challenges and celebrates accomplishments
• You are an effective communicator, promoting clear, direct and timely communication within your own team and across the organization
• You are excited to meet face to face with Alliance providers and get to know the network and geographical region

WHAT YOU’LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements please visit our website
Knowledge of:
o Medi-Cal, Medicaid, Medicare, and entitlement programs, and related regulations
o Promoting and applying change management principles
o Principles and practices of program development and project management
o Research, analysis and reporting methods
o Tools and techniques of gap analysis and survey administration
o Provider contracting requirements, processes and practices
o Standard negotiating and marketing techniques
o Provider credentialing requirements, processes and practices
Ability to:
o Direct, manage, supervise, mentor, train and evaluate the work of staff
o Develop, plan, organize and direct programs and activities that are complex in nature and regional in scope
o Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues
o Review and assess overall department function, core work, goals and structure, develop and implement short- and long-term planning to achieve strategic plans, and complete an annual department assessment
o Demonstrate a collaborative management style, build rapport, and effectively manage internal and external business relationships
o Make presentations and adjust communication style in order to facilitate collaboration and understanding
Education and Experience:
o Bachelor’s degree in Public Health, Healthcare Administration or a related field
o Ten years of relevant experience in healthcare operations, with demonstrated experience in the negotiation of contracts between health care payers and health care providers, including three years of management-level experience, and either three years of experience in managed care provider services or five years of experience in community relations, public relations or public assistance programs (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER DETAILS
• While this position is connected to one of our Alliance offices, we are in hybrid telecommute work environment right now and we anticipate that the interview process will take place remotely.
• Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
• Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

COVID-19 Vaccine Requirement: This position requires staff to be fully vaccinated and boosted upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated is defined as receipt of the second dose in a 2-dose series (ex: Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (ex: Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

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