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Director, Provider Relations

Columbus, Ohio Apply Now Job ID 1174520 Additional Locations US,Ohio;Cincinnati,US,Ohio;Ohio Category Network Development & Contracting Organization Buckeye Community Health Plan Schedule Full-time
Description:

The Director Provider Relations develops and implements provider relations strategies and policies. Develops and maintains positive relationships with health care providers for multiple or complex provider contracts across Ohio to support all lines of business, with particular focus on state and federal Government contracts. Manages the activities and/or regional provider staff responsible for servicing the network, consistent with company goals and objectives. Develops and creates relationships with providers and program representatives that will enhance the company’s presence, improve provider performance, and increase membership in the assigned programs and markets.


* Develops goals, work plans and schedules for regional provider relations staff and ensures that they are executed. Responsible for the day-to-day supervision and monitoring of provider relations administration and operations for regional and/or statewide providers.
*  Responsible for timely data analysis and held accountable that information is presented internally and externally in an accurate, timely and professional manner, including presentations and education as needed.
*  Oversees monitoring of provider network database for accuracy and timeliness; makes corrections as needed.
*  Plans and coordinates the addition of health care providers within an assigned geographical area and monitors the performance and capacity of existing providers; researches and recommends the addition of health care providers within an assigned geographical area.
*  Plans and coordinates as necessary, support and activities with important community organizations to facilitate positive working relationships.
*  Determines which providers need assistance in managing Buckeye programs, and assists them in developing corrective action plans.
*  Develops approach to improve and enhance the image of the company with providers/practitioners/program representatives.
*  Facilitates problem resolution for complex problems between providers, marketing, claims, member relations and employer groups.
*  Develops and executes a “Net Growth” plan to maximize membership growth statewide and within targeted market segments.
*  Collaborates with internal departments to facilitate improved encounter data submissions, increased HEDIS scores, STAR rating, NCQA scores, and other regulatory measures.
*  Where appropriate, interfaces with state and local officials, committees, and collaborates to continually improve Buckeye positioning to achieve organizational goals
*  Ensures that Provider Relations staff is adequately trained in all skills necessary and appropriate to their job, including but not limited to the following areas: contract interpretation and clarification, marketing programs, Buckeye products, customer service, provider relations interactions, regulatory requirements, and project management.
*  Consults with Organization Effectiveness on Human Resources related issues for the region, including but not limited to selection, conflict resolution, staff development, and performance evaluations.
Other duties as assigned.

Qualifications:
Education & Experience:

 
*  Bachelor’s degree in Health Services, Health Care/Hospital Administration required, or related field or equivalent health care experience; Master’s degree preferred.
*  Seven to nine years extensive provider network management/health care management experience
*  Strong project management experience plus previous supervisory/management experience required.
*  Experience in a health care management environment, including exposure to provider servicing, benefits interpretation, and internal operations of provider relations function.
OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.



Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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