Director, Provider Relations

Under the direction of the Vice President, Provider Relations, the Director of Provider Relations is responsible for establishing, maintaining, and growing strategic relationships with providers, ensuring a collaborative partnership that enhances the quality of care. Supports the organization's growth goals, initiatives, and strategic priorities. Works effectively to improve the experience for referring providers and collaborate with leadership to implement organizational strategies. Prepares various reports of network needs service coverage and performs quality checks to ensure the integrity of systemic provider files and provides trend analysis. Also responsible for all Provider Communications and Training activities.

Must report on site in New Jersey 5 days a week

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To be successful, an individual must be able to perform each essential duty and responsibility satisfactorily.

• Work closely with the Vice President to develop and implement a comprehensive provider relations strategy to foster strong partnerships with key providers and retail providers, including a strategic plan for network reimbursements.
• Act as liaison between the NVA and healthcare providers, addressing inquiries, concerns, and feedback.
• Creation and maintenance of a customer service model for internal and external customers.
• Identify opportunities for new partnerships and negotiate contracts with healthcare providers with the Vice President.
• Analyze market trends and provider network performance to inform strategic decisions.
• Ensure compliance with regulatory requirements, as applicable and industry standards.
• Management of on-going provider communications (ECP and Retail).
• Initiates and implements processes of ensuring the website and provider directory accurately contains current information.
• Creates and maintains databases for enrollment, complaints, etc. and provides trend analysis.
• Creates Policies and Procedures that control the network functions.
• Communicates pertinent provider issues to applicable internal customers and the Vice President.
• Creates and maintains all provider manuals.
• Development of templates and management of Plan Sheets, including creation of manual sheets.
• Provider wake up process, including the drafting and coordination of mailing letters, based on group demographics.
• Ownership of any Internal Improvement Plans (IIPs) related to department functions.
• Oversees multiple projects simultaneously.
• Other duties as assigned.
  
  

SUPERVISORY RESPONSIBILITIES: Responsible for supervising Credentialing and Provider Recruitment Teams (3-5 employees) and others as may be necessary.

QUALIFICATION REQUIREMENTS:

• Bachelor’s degree in business or related health care management field. Significant additional experience can be considered in lieu of a degree with some college.
• 5 years’ minimum experience in Network Management and Relationship Development of Health Care Plans and Providers in a capacity of a managed care or vision company.
• Excellent oral and written communication skills and able to communicate effectively with all customers.
• Computer skills with Microsoft office and with experience in MS Word, Excel, PowerPoint, Access and exchange or outlook email.
• Demonstrated leadership skills.
• Demonstrated strong organizational, analytical and problem-solving skills.
• Ability to multi-task, shifting back and forth effectively among multiple activities.
• Travel as required.