Director, Provider Relations

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Job description

Overview

Job Summary

The Director, Provider Relations is responsible for leading a team that spans across markets, lines of business and clients. This position assists the Market President in developing and executing the strategy and performance of the provider network and network outcomes. This is a collaborative role requiring critical thinking skills, independence, leadership, a strategic mindset, and attention to detail.

Responsibilities

* Work closely with Sales to support service and product revenue growth, customer acquisition and customer satisfaction.
* Partner with Executive Directors and Director of Clinical Operations to support network initiatives.
* Work closely with Data Management teams on claims processing, resolution issues, and provider performance tool enhancements to better serve the PAC environment.
* Support companywide initiatives, marketing the naviHealth brand and evolving Provider Operations.
* Work closely with Product Teams to ensure new developments align with provider expectations.
* Analyze, summarize, and supports claims-based change management performance at acute and PAC levels anticipating and creating actionable plans that drive network performance change at the client level supporting the Market President and Director, Clinical Operations' internal KPI goals.
* Analyze, summarize, and create action plans using the semi-annual Provider Satisfaction Survey results.
* Remain current on all regulatory changes in the acute and post-acute care environment.
* Drive performance and execute on strategic initiatives within the provider network.
* Understand and influence the impact of regional/national providers in the market.
* Guide pay for performance modeling for clients.
* Collaborate with clients to develop or narrow networks to high performing.
* Speak to naviHealth products such as provider portal, nH Perform, SADB.
* Direct the activities of Network Managers including hiring, onboarding, and professional development activities.
* Develop, analyze, and deliver RFI/Service Capability requests/ Collaboration Agreements.
* Support clients in contract negotiation activity and re-writes.
* Serve external customers - oversee provider advisory councils and manage provider grievances/complaints.
* Represent the Network/Provider Engagement Team in requests for strategic alliances with providers as well as trade agencies.
* Perform other duties and responsibilities as required, assigned, or requested.

Qualifications

* Bachelor's degree in Business or a Health Care related field with sales and marketing focus preferred; Master's Degree preferred
* At least 10 years of relevant experience required, including 5 years in a management/leadership role
* Strong analytical skills
* Effective negotiation and influencing skills
* Detail-oriented
* Self-starter with effective communication skills
* Ability to complete initiatives with minimal supervision
* Excellent presentation skills with high Emotional Intelligence
* Ability to build and foster relationships inside and outside the organization
* Ability to independently plan, organize and prioritize work
* Ability to influence others
* Ability to educate
* Willingness to work toward team objectives
* Ability to manage direct reports/team members effectively
* Ability to make appropriate organizational determinations in accordance with naviHealth standards of practice independently and timely
* Experienced in managed care, health plan operations in provider contracting, customer service or provider relations preferred
* Strong brand promotion and management skills
* Proficiency with Microsoft Office applications
* Strong knowledge in Acute and Post-Acute Care Continuum
* Ability to travel extensively may be required

Work Conditions and Physical Requirements

* Ability to establish a home office workspace
* Ability to manipulate laptop computer (or similar hardware) between office and site settings
* Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard time period
* Ability to communicate with clients and team members including use of cellular phone or comparable communication device
* Ability to remain stationary for extended time periods (1-2 hours)
* Travel requirements
* Ability to travel to markets supported by naviHealth to recruit and monitor field staff, and to interact with clients and physician groups on program protocols and outcomes up to 50% of the time

About naviHealth

naviHealth is improving the healthcare experience for seniors to live more fulfilling lives. For nearly a decade, naviHealth has been a trusted partner for the nation's top health plans, health systems, and at-risk physician groups navigating the shift from volume to value. Powered by a predictive technology and decision support platform that provides clinicians and care teams with evidence-based protocols, naviHealth's high-touch, proven care model fully supports patients from pre-acute through to the home. With naviHealth, patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions. For more information about naviHealth, visit navihealth.com.

Our Purpose

Improving the healthcare experience for seniors to live a more fulfilling life

Our Values

Rooted in respectGuided by purpose Devoted to service Energized by impact

The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications. naviHealth reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.

naviHealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other protected status under applicable laws and will not be discriminated against on the basis of disability.