Director Provider Network Management

Corewell Health • Grand Rapids, MI

11h

About The Position

Establish and maintain productive relationships with providers across geographic regions and/or large health care delivery systems. Understand market dynamics, including mergers and acquisitions, and delivery system expansion plans, including physician employment strategies. Link Priority Health's strategic objectives with delivery system initiatives to identify opportunities to create incentives to support quality improvement and cost reduction, while improving patient satisfaction. Essential Functions Develop and maintain purposeful, long term relationships with providers based on fair and competitive business terms, with an emphasis on improving quality and the patients' experience of care, while reducing the cost of care. Oversee and direct collaborative efforts with providers in designated communities to identify improvement opportunities, develop action plans and successfully implement them. Direct the activities of the team, which many include Managers, as well as Sr. Provider Account Representatives and the Provider Account Representatives, establishing annual performance objectives and monitoring the interface between team members and network providers to ensure annual goals are achieved. Provide advice/guidance/recommendations to corporate and regional executives and business partners related to various risk arrangements, costs, cost-savings opportunities, best practices, provider performance issues, provider compensation and network expansion. Support market specific business needs for designated communities including attending slide presentations and providing market specific data and intelligence. Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis. Performs other duties as assigned.

Requirements

• Bachelor's Degree in health care administration, business administration, accounting, finance, clinical or health and human services
• 5 years of relevant experience within provider network management, health care insurance or other health care delivery setting
• 5 years of relevant experience directly interacting with clinical practices, including experience analyzing and integrating financial and quality performance
• 5 years of relevant experience in direct management of staff
• LIC-Driver's License - STATE_MI State of Michigan Upon Hire required

Nice To Haves

• Master's Degree (MBA, MHA, MHP)
• 5 years of relevant experience
• 5 years of relevant experience Strong contextual knowledge related to managed care, provider reimbursement models, national health care trends and practice management

Responsibilities

• Develop and maintain purposeful, long term relationships with providers based on fair and competitive business terms, with an emphasis on improving quality and the patients' experience of care, while reducing the cost of care.
• Oversee and direct collaborative efforts with providers in designated communities to identify improvement opportunities, develop action plans and successfully implement them.
• Direct the activities of the team, which many include Managers, as well as Sr. Provider Account Representatives and the Provider Account Representatives, establishing annual performance objectives and monitoring the interface between team members and network providers to ensure annual goals are achieved.
• Provide advice/guidance/recommendations to corporate and regional executives and business partners related to various risk arrangements, costs, cost-savings opportunities, best practices, provider performance issues, provider compensation and network expansion.
• Support market specific business needs for designated communities including attending slide presentations and providing market specific data and intelligence.
• Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis.
• Performs other duties as assigned.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• Learn more here .
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees