Director, Provider Network Management

Scripps Health • San Diego, SC

2d • Onsite

About The Position

As Director, Provider Network Management, you will be responsible for creating and maintaining a comprehensive contracted provider network to serve Scripps Health Plan members. This role blends financial analysis, contract negotiations, operational efficiency, and system-wide impact, working extensively with Scripps Health Plan Services, stakeholders across the organization, and external providers and vendors. Scripps Health Plan operates as both an MSO and a KK-licensed plan for large commercial groups.

Requirements

• At least seven years combined experience in management of provider relations and contracting at the plan, medical group /IPA level
• Four years must be in a leadership capacity.

Nice To Haves

• Masters degree in healthcare administration or similar
• Epic Tapestry experience
• Negotiation skills
• Creating policies and procedures
• Leading multiple teams

Responsibilities

• Oversee the credentialing, provider database, contracting, and provider relations teams.
• Lead provider relations functions, including training, problem-solving, and provider satisfaction initiatives for all medical groups, IPAs, institutional providers, and ancillary providers.
• Be responsible for Customer Service related to both member and provider inquiries.
• Maintain provider directories for all contracted IPAs and medical groups.
• Support Scripps' integrated delivery system.
• Manage relationships related to Scripps Health Plan's plan-to-plan risk arrangements with major HMO plans.

Benefits

• This position is eligible to participate in the Director Incentive Plan.
• transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career.

What This Job Offers

• Job Type: Full-time
• Career Level: Director