Senior Director of Provider Relations

Amida Care is a Diversity, Equity, and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote, and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

The Senior Director of Provider Services and Network Management is responsible for the overall
planning, implementation, evaluation and day-to-day management of the Provider Services Department, and is responsible for ensuring the development and maintenance of a network of providers sufficient to ensure provision of the Plan benefits.

ESSENTIAL FUNCTIONS
Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.

• Serve as the senior leadership point person for provider network services and performance in all activities, meetings, and committees of the organization and with internal and external audiences, including providers, vendors, and State regulators; serve in the stead of the EVP on these matters internally and externally as needed.
• Responsible for oversight, management and reporting for all providers participating in the Quality Incentive Program. Develops value-based contracting metrics, contract monitoring procedures and ensures achievement of contract administration/metrics objectives.
• Drive the design and development of a robust suite of analytical tools and provider performance metrics that will serve to inform enhance provider performance strategies, priorities, and activities as a key factor in achieving results; acts as business sponsor and owner for all Provider department reporting and technology systems needs and ensures active and proper usage of those systems.
• Develop and retain effective relationships with physician and business leadership of key physician groups, ancillary providers, and delivery systems to drive business results.
• Perform basic financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives.
• Develop and implement clear and documented processes for provider operations (e.g. provider manual, provider communications, and provider on-boarding).
• Negotiate large hospital, physician groups and ancillary service agreements in accordance with Corporate, health plan and government regulations and guidelines.
• Oversees the development, maintenance, and reconciliation of physician risk contracts and capitated arrangements in partnership with internal support teams such as Finance, Healthcare Economics, and Value-Based Operations.
• Manage the Credentialing Manager and department; ensure all credentialing functions are operating timely and according to policy and regulatory requirements.
• Responsible for the hiring and retention of quality staff and the on-going planning, monitoring, training, coaching, evaluation, and appraisal of staff performance and development to ensure successful achievement of goals and objectives.

MINIMUM JOB REQUIREMENTS

• Master’s degree or J.D. plus 5 years’ experience in contract negotiations and network development, or 5 years’ experience in Health Care management, and/or Managed Care;
OR
• B.A. plus 7 years’ experience in contract negotiations, network development, Health Care management, or Managed Care experience, including contract negotiations and network development
• Strong analytical and organizational skills.
• Advanced proficiency in Microsoft Office software (Word, Access, and Excel).
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.

Position Description »