The Director of Provider Network Management & Member Servicesis responsible for executing revenue-driven initiatives in a highly competitive marketplace by developing and implementing effective Provider Network, Provider Relations and Member Service strategies. Ensures thoughtful and tactical network development, physician recruitment and provider maintenance to attract and retain members.
Responsible for maintaining and nurturing effective relationships with providers, health plans, hospitals and local community resources. Collaborates and markets networks with brokers and health plan career agents to increase membership across targeted product lines. Identifies and seizes new business opportunities to ensure achievement of revenue-driven objectives.
Principal Duties and Responsibilities:
- Responsible for monitoring network adequacy, and in partnership with the Director of Contracting, alignment of necessary specialties to ensure access to necessary medical specialties including tertiary services.
- Keeps informed on new provider compensation strategies or methodologies such as capitation, bundled payments, and pay for performance opportunities or other means of compensation incentives to engage providers with Seaside strategies.
- Responsible for monitoring and oversight of provider data integrity in accordance with SB 137.
- Organizes and/or conducts effective Joint Operation Committee meetings and/or management review sessions with designated providers and/or groups to further Seaside's goals.
- Responsible for effectively managing an operating budget, quality benchmarks and establishing membership targets and increasing membership though retention or new members.
- Provides leadership and direction; develops metrics and tools to measure/effect progress on team goals: increase revenue and reduce unnecessary expenses.
- Provides guidance to Managers with interviewing, hiring, performance evaluations, training, staff development, employee engagement and issue resolution.
- Provides employees with opportunities for professional growth and development through ongoing performance feedback and performance appraisals; coaching for success; removing barriers for achievement of goals, communicating a clear vision and influencing and motivating employees to achieve business results.
- Responsible for ensuring compliance with company and regulatory requirements.
- Focuses on process improvement and strategies to increase effectiveness including LEAN initiatives, utilizing technology, people and standard work.
- Fosters a positive corporate culture by promoting and demonstrating the company's vision and values.
- Collaborate with management and staff from other departments to develop standard processes, resolve issues and further the business goals of the company.
- Minimum of 5 years' experience in management role(s).
- 5+ years of experience in the healthcare industry, preferably with direct physician interaction
- Strong computer skills, Word, Excel, Access, PowerPoint, and office equipment
Bachelor degree in Business Administration, Health Care Administration or related field. Masters degree preferred