Director of Provider Services

Neighborhood Health Plan of RI

Director of Provider Services 


Overview: 

The Director of Provider Services is responsible for the tactical and strategic
operations of the Neighborhood Provider Services team.  The keys to success in this
position are exceeding organizational expectations concerning contract
negotiations and implementation, and ensuring that provider expectations
related to support and coordination are met.

The Director of Provider Services will provide leadership and direction to
provider/contract management teams who are responsible for maintaining and
improving relationships with provider entities including Community Health
Centers and other primary care providers, hospitals, specialty providers,
and medical equipment suppliers.  Each provider/account management team is
responsible for ongoing administration of contractual relationships between
Neighborhood and providers, as well as, resolving operational issues that impact
providers.

The Director of Provider Services will assess the impact of new business
on the Provider Services area and implement initiatives that will provide
the necessary operational support to contribute to Neighborhood’s successful
expansion into new markets. The Director of Provider Services will identify
dependencies on other areas of Neighborhood, and will work with peers to ensure
that operations are aligned with corporate goals.

The Director ensures that Neighborhood effectively and efficiently uses and plans
for resources related to these functions and serves as part of corporate
leadership team providing strategic direction and management for the
organization.


Qualifications:

Required: 
- Bachelor’s degree in Business or Health-related discipline, and/or
  years of experience and background equivalent to this degree
- 8+ years of experience developing and negotiating contractual and
  financial arrangements with strategically important providers
- Demonstrated effectiveness in strategic planning
- Demonstrated ability to work with C-level executives to define and
  implement strategies that led to significant competitive advantage
  in the marketplace
- Demonstrated leadership effectiveness, analytical capability and
  ability to design and implement constructive change
- Demonstrated communication, organization, project management and
  interpersonal skills
- Demonstrated knowledge of best practices that drive an environment
  of continuous improvement-* Broad knowledge of the managed care
  industry and demonstrated ability to apply that knowledge to improve
  performance and impact the stability of the enterprise

Preferred:
- Master’s degree in Business or Health-related discipline
- 8+ years of health care experience, preferably in managed
  Medicaid / Medicare
- Demonstrated experience leading a provider relations function in a
  managed care organization
- Ability to evaluate applicable technologies and effectively support
  implementation of required technology changes, when appropriate

Duties and Responsibilities: 
 
- Lead the development and negotiation of contractual and financial arrangements with complex providers, e.g. hospitals and other
  facilities, primary care physicians, ancillary providers, etc.
- Create and maintain positive provider relationships
- Oversee the management all operational aspects of Neighborhood’s provider relationships.
- Ensure that the work of their assigned Provider Service Teams is coordinated and supportive of Neighborhood goals in the development and
  planning of the provider contracting and incentive initiatives
- Work collaboratively with business and operational units to ensure the provider operations are supported by effective, accurate and
  efficient business processes; reimbursements are accurately defined, communicated and configured; all provider communications are compliant
  and reports are accurate, timely and meet all contractual requirements
- Identify and resolve operational, benefit, data, and communication
  issues that inhibit effective provider/contract relationships
- Coordinate and ensure timely and accurate implementation of special projects, many of which are cross-departmental
- Keep current on organizational and industry issues, skills and practices and translates this knowledge into effective improvements
  within the provider/contract administration teams
- Engage in on-going performance management with provider/contract administration staff including coaching, mentoring, development and
  succession planning
- Monitor proposed/approved changes to state and federal law, assess the impact on provider service functions; and institute / coordinate
  changes as required to remain compliant with regulations governing Neighborhood and his/her assigned staff functions (e.g.: HIPAA; Fraud, Waste and Abuse).
- Work with the Senior Management Team in the development and implementation
  of the strategic and annual plans
- Lead Neighborhood analysis and strategy in defining provider network to serve Neighborhood members.
- Develop and manage operating and capital budget for the department

Departmental Planning:
- Develop vision and strategy for assigned functions
- Develop and implement work plans that are consistent and supportive of Neighborhood’s strategic and annual plans
- Support and mentor Managers in execution of their respective work plans
- Ensure that department/appropriate Neighborhood Policies and Procedures are
  maintained
- Represent Neighborhood in appropriate committees (e.g. OHIC work groups) or meetings
- Other duties as assigned


Neighborhood is an Equal Opportunity Employer