Strategizes for optimal business practices and efficiencies with an emphasis on provider satisfaction, optimal quality scores and producing review for the corporation. Position plans, provides resources and directs activities in the provider service functions. Directs special project by provider relations to include Network Management, increased electronic transactions, and cost of care reduction.
Reports to: VP, Field Network Mgmt.
Dept.: Provider Relations
Location: Louisville, Lexington, Ashland, Bowling Green, Owensboro, Hazard
- Sets goals for statewide team 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 services and oversees excution by provider relations team.
- Develops practices to assist risk partners in managing finanial risk.
- Performs data analysis and develops specific actions to manage medical cost trends.
- Plans, provides resources and directs activities of the provider service functions.
- Develops provider service strategies with ownership to ensure 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.
- Resolves high level, complex provider issues.
- Member of state senior leadership team.
- Special project as assigned or directed.
Bachelor's degree or equivalent work experience required.
10 years in provider relations experience with 5 years in a management role. Managed care experience highly perferred.
Demonstrated leadership to implement change and drive business results
Strong people management and facilitative skills
Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace
Excellent interpersonal skills and demonstrated ability to influence internal and external constituents
Excellent analytical skills and ability to convert related activities into a comprehensive work plan
Strong knowledge of CMS and state regulations.
- Technical Skills/Requirements: Advanced MS Word and Excel with proven analytical and financial skills.