Director Provider Network Management- Bakersfield 1.1
About The Position
The Director of Provider Network Management holds a pivotal role in overseeing and optimizing the provider network for our esteemed healthcare organization. This position entails cultivating and nurturing relationships with healthcare providers, orchestrating contract negotiations, and ensuring providers uphold the highest quality and service standards. The Director will play a strategic role in expanding the network, scrutinizing provider performance, and adeptly managing the contracting lifecycle. This role ensures that all healthcare providers meet the necessary qualifications and standards set forth by regulatory bodies, and internal policies.
Requirements
- Bachelor's degree in business, healthcare administration, or a related field; advanced degrees are advantageous preferred.
- Possess a minimum of 5 years of demonstrated experience in healthcare provider relations, network management, or comparable domains.
- Extensive comprehension of healthcare provider networking, contracting, and credentialing dynamics.
- Showcase masterful negotiation skills and communicate with exceptional efficacy.
- Exhibit thorough knowledge of healthcare regulatory obligations and accreditation standards.
- Demonstrate adeptness in Microsoft Office suite and proficient database management.
- Boast exceptional interpersonal skills, pivotal for forging and sustaining meaningful relationships.
- Travel when necessary.
Responsibilities
- Strategically lead and manage the provider network while ensuring unwavering adherence to organizational benchmarks and requisites.
- Spearhead the identification and recruitment of new providers to strategically broaden the network's reach.
- Leverage your exemplary negotiation skills to initiate and oversee contract negotiations, while meticulously tracking compliance with contractual obligations.
- Continuously conduct comprehensive assessments of provider performance, encompassing the evaluation of quality metrics and customer satisfaction metrics.
- Collaborate effectively with providers to promptly address concerns, swiftly resolve issues, and ensure seamless solutions.
- Foster and nurture robust relationships with providers, cultivating an atmosphere of collaboration and partnership.
- Devising and executing strategies to elevate network performance and fortify provider engagement.
- Remain vigilant about industry trends and regulatory modifications impacting provider networks.
- Foster harmonious alignment and integration of provider network strategies with other organizational departments.
- Develop, implement, and maintain efficient and effective credentialing processes for onboarding new healthcare providers and renewing existing credentials.
- Review applications, certifications, licenses, education, training, work history, and references to determine eligibility and compliance.
- Coordinate with various departments to gather required documentation for credentialing purposes.
- Stay current with industry regulations, accrediting agency requirements, and licensing standards to ensure continuous compliance.
- Develop and implement policies and procedures to meet regulatory and organizational standards related to credentialing and privileging.
- Provide training and education to staff and healthcare providers regarding credentialing requirements, processes, and best practices.
- Maintain accurate and confidential records of credentialing and privileging activities in accordance with legal and organizational requirements.
- Other duties as assigned.
Benefits
- Medical
- Dental
- Vision
- Paid Time Off (PTO)
- Floating Holiday
- Simple IRA Plan with a 3% Employer Contribution
- Employer Paid Life Insurance
- Employee Assistance Program
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What This Job Offers
Job Type
Full-time
Career Level
Director
Number of Employees
1-10 employees
