Director, Provider Relations(Must Live In Massachusetts, Preferred Experience In Provider Relations, Network Operations & Duals Plans)

CareSource

About The Position

Job Summary: The Director, Health Partner Engagement directs, oversees, and manages strong relationships with key Health Partners throughout the state to ensure CareSource delivers and meets the specifications of our Health Partner contractors. Essential Functions: Identifies and fosters communications with Health Partners to reduce high cost utilization trends; possesses a strong financial acumen to ensure Health Partner contract financial targets are met and/or exceeded Works with Health Partner stakeholders to evaluate policy and process changes for potential impacts, monitors implementation of key initiatives, and provides leadership on key initiatives affecting Health Partners Manages Health Partner Relations team that conducts research into Health Partner issues and drives them to completion for the Health Partner network Actively engages Health Partner associations and Health Partners to identify opportunities to strengthen relationships and identify collaboration opportunities Accountable to lead Health Partner Relations team that promotes achievement of Quality measures and withhold targets with Health partners; works with Health Partners to educate on HEDIS & CAHPS measures and facilitates process of measures data collection for all lines of business Consults with Health Partner Contracting leadership to assist in the development and execution of negotiation plans; lead and/or assist with negotiations as agreed upon with Contracting leadership Effectively leads the Health Partner Relations team, including specialists, analysts, and regional concierge, and health partner managers as evidenced by Health Partner, internal customer and client satisfaction, compliance with internal, client, regulatory and accreditation standards, successful audits, and employee satisfaction and engagement Directs Health Partner Relations staff to assure day-to-day activities are performed effectively and support the market’s network strategy, including meeting financial targets In collaboration with Network Management Leadership, executes on a process improvement strategy which identifies Health Partner satisfaction impacts and root cause of issues to achieve shorter Health Partner inquiry response times, improved employee engagement, and higher Health Partner satisfaction Ensures CareSource complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards and participates in market audits Provides education, leadership, analysis and ongoing support in the areas of Cost of Care, Value-Based Reimbursement, and cost saving initiatives for the Health Partner relations team and the Health Partner Network Understands change management, translates goals and objectives into practical integrated solutions, and delivers on financial value to the Health Partner and CareSource Responsible for the development and communication of performance improvement measurements, working with the Health Partner developing to develop strategies for success Responsible for working cross functionally to assure health partner communications and portal messaging is consistent and provides best in class direction for our health partners Provides regional leadership to cross functional teams while coordinating services and support to achieve all market goals set forth by the Market Responsible for hiring, managing and ongoing training of the Health partner relations team, providing leadership and coaching to staff on strategy, best practices and professional development and developing and maintaining high team engagement Development and management of an annual budget Perform any other job related instructions, as requested

Requirements

Bachelor’s degree or equivalent years of relevant work experience is preferred
Minimum of seven (7) years of health plan/managed care experience is required, with at least three (3) years of leadership experience preferred
Comfortable working with diverse organizations and in facilitating solutions to competing priorities and interests while maintaining a balance among stakeholders’ needs
Demonstrated leadership experience, knowledge of managed care best practices, experience driving strategic partnerships and operational improvements, and excellent communication skills
Expert collaborator adept at maintaining and fostering relationships with Health Partners and key stakeholders
Is well versed and up to date in Medicaid, Medicare and Marketplace program managed care regulations for the market
Strong verbal and written communication skills
Leadership capabilities in a diverse, multifaceted, operation that serves multiple stakeholders
Strong management, budgetary, and operations skills
Understanding of administrative, technical, and clinical dimensions of health care and how these dimensions inter-relate
Organized, resourceful, and capable of effectively multitasking to ensure competing priorities are addressed in a timely and efficient manner
Employment in this position is conditional pending successful clearance of a driver’s license record check
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position
CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment
Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified
CareSource adheres to all federal, state, and local regulations
CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position
Request for accommodations will be completed through an interactive review process
A valid driver’s license, car, and insurance are necessary for work related travel

Nice To Haves

Must Live In Massachusetts
Preferred Experience In Provider Relations, Network Operations & Duals Plans
Master’s degree is preferred

Responsibilities

Identifies and fosters communications with Health Partners to reduce high cost utilization trends
Works with Health Partner stakeholders to evaluate policy and process changes for potential impacts, monitors implementation of key initiatives, and provides leadership on key initiatives affecting Health Partners
Manages Health Partner Relations team that conducts research into Health Partner issues and drives them to completion for the Health Partner network
Actively engages Health Partner associations and Health Partners to identify opportunities to strengthen relationships and identify collaboration opportunities
Accountable to lead Health Partner Relations team that promotes achievement of Quality measures and withhold targets with Health partners
Consults with Health Partner Contracting leadership to assist in the development and execution of negotiation plans
Effectively leads the Health Partner Relations team, including specialists, analysts, and regional concierge, and health partner managers
Directs Health Partner Relations staff to assure day-to-day activities are performed effectively and support the market’s network strategy, including meeting financial targets
In collaboration with Network Management Leadership, executes on a process improvement strategy which identifies Health Partner satisfaction impacts and root cause of issues to achieve shorter Health Partner inquiry response times, improved employee engagement, and higher Health Partner satisfaction
Ensures CareSource complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards and participates in market audits
Provides education, leadership, analysis and ongoing support in the areas of Cost of Care, Value-Based Reimbursement, and cost saving initiatives for the Health Partner relations team and the Health Partner Network
Understands change management, translates goals and objectives into practical integrated solutions, and delivers on financial value to the Health Partner and CareSource
Responsible for the development and communication of performance improvement measurements, working with the Health Partner developing to develop strategies for success
Responsible for working cross functionally to assure health partner communications and portal messaging is consistent and provides best in class direction for our health partners
Provides regional leadership to cross functional teams while coordinating services and support to achieve all market goals set forth by the Market
Responsible for hiring, managing and ongoing training of the Health partner relations team, providing leadership and coaching to staff on strategy, best practices and professional development and developing and maintaining high team engagement
Development and management of an annual budget
Perform any other job related instructions, as requested