Strategizes for optimal business practices and efficiencies with an emphasis on producing revenue for the corporation. Position plans, provides resources and directs activities in network development, provider contracting/negotiation and provider service functions.
Reports to: VP, Medicare Executive Director
Dept.: TN - Exec-State
Location: Brentwood, TN
Additional Responsibilities:Candidate Education:
- Sets goals for their area and works closely with Managers/Representatives to drive performance and to ensure provider satisfaction metrics are met or exceeded.
- Conducts field rides with Provider Relations Representatives to gauge their performance and provide coaching and development in order to improve the business results.
- Plans, conducts and directs provider contracting/negotiations and provider servicing.
- Develops practices to assist risk partners in managing financial risk.
- Performs data analysis and develops specific actions to manage medical cost trends.
- Plans, provides resources and directs activities, network development, provider contracting/negotiation and provider service functions.
- Develops provider contracting and service strategies and ensures maximum efficiencies in the utilization of human and financial resources.
- Strategizes for membership growth, retention, and to affect sophisticated or complex provider relationships.
- Maintains compliance for State and CMS audits.
- Special projects as assigned or directed.
- A Bachelor's Degree in a related field or equivalent work experience
- Required 7 years of experience in provider relations or similar background
- Required 4 years of experience in management
- Intermediate Demonstrated leadership skills
- Intermediate Ability to lead/manage others
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to influence internal and external constituents
- Advanced Demonstrated analytical skills
- Advanced Other Facilitative skills
- Intermediate Other Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace
- Intermediate Other Ability to convert related activities into a comprehensive work plan
- Advanced Other Financial skills
- Advanced Other Knowledge of CMS and state regulations
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel