Director, Ohio Market Provider Contracting
About The Position
The Director, Provider Contracting executes contracting strategy, develops provisions based on cost, quality/analysis and monitors key metrics. This role is responsible for provider recruitment, implementation of contracts, and the administration of provider contracts, terms, and reimbursement rates in compliance with corporate policies. The position also involves ensuring the network is adequate, cost-effective, competitive, stable, and meets corporate & regulatory requirements, as well as performing gap analysis and implementing solutions to mitigate risk. Additionally, the Director will manage access grievance intake, analysis, and performance improvement initiatives, and support the contracting requirements for geographic regions and products.
Requirements
- Bachelor’s degree in a healthcare related field, or equivalent work experience is required
- Minimum three (3) years of contract negotiation experience is required
- Minimum three (3) years of management experience is required
- Intermediate proficiency level with Microsoft Outlook Word, and Excel
- Knowledge of Network Management Processes & Services
- Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
- Effective oral and written communication skills
- Critical listening and thinking skills
- Training/teaching skills
- Time management skills
- Influenza vaccination is a requirement of this position.
Nice To Haves
- Master’s Degree or equivalent work experience is preferred
- Managed care experience is highly preferred
Responsibilities
- Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting
- Ensure an ongoing high level of staff engagement, empowerment and development
- Responsible for provider recruitment, implementation of contracts
- Responsible of contracts and testing, initiating set-up, post configuration testing, maintenance and audit of claims system
- Create contract language and review with legal to develop approved contract templates
- Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
- Implement an efficient and effective process to on-board new providers; ensure network is adequate (access for members), cost-effective, competitive and stable, and meets corporate & regulatory requirements
- Responsible for ensuring all regulatory requirements for provider network are met
- Perform gap analysis to ensure no gaps and/or sanctions occur; identify & implement solutions that mitigate risk; development of corrective action plans as needed
- Responsible for access grievance intake, analysis and performance improvement initiatives
- Participate in training sessions for providers and staff as appropriate
- Support the contracting requirements of the corporation for geographic regions and products
- Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis
- Assist with development and review of payment policies and provider notifications
- Collaborate with appropriate personnel with process of reassignment of members related to provider terminations, as required by the state
- Perform any other job related instruction as requested
Benefits
- bonus tied to company and individual performance
- substantial and comprehensive total rewards package
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What This Job Offers
Job Type
Full-time
Career Level
Director
