31 applicants

Company

CareSource · 1 day ago

Director, Provider Relations(Must Live in Ohio)

United States

Full-time

Remote

Lead/Staff, Director/Executive

7+ years exp

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Comp. & Benefits

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Responsibilities

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

Qualification

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Health plan experienceManaged care regulationsLeadership experienceBudget managementMultitasking abilitiesStakeholder managementCollaboration skills

Required

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. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated

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.