Director Provider Relations

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Chicago, IL
$120,000 - $135,000
Job Type
Direct Hire
Bachelor of Arts
Feb 28, 2018
Job ID
As a Director of Provider Relations, the incumbent will have the opportunity to Strategize optimal business practices and efficiencies with an emphasis on producing revenue for the corporation. Position plans, provides resources and directs activities in network development, provider contracting/negotiation and provider service functions.

Essential Functions:

  • Sets goals for their area and works closely with Managers/Representatives to drive performance and to ensure provider satisfaction metrics are met or exceeded.
  • Conducts field rides with Provider Relations Representatives to gauge their performance and provide coaching and development in order to improve the business results.
  • Plans, conducts and directs provider contracting/negotiations and provider servicing.
  • Develops practices to assist risk partners in managing financial risk.
  • Performs data analysis and develops specific actions to manage medical cost trends.
  • Plans, provides resources and directs activities, network development, provider contracting/negotiation and provider service functions.
  • Develops provider contracting and service strategies and ensures maximum efficiencies in the utilization of human and financial resources.
  • Build strategy for membership growth, retention, and to affect sophisticated or complex provider relationships.
  • Maintains compliance for State and CMS audits.
  • Special projects as assigned or directed.

Ideal candidate will have 7+ years experience in Healthcare Provider Relations with a minimum of a Bachelor's Degree in a related field or equivalent work experience.  In addition 4 years of management experience is required.

Candidate Skills:
  • Stakeholder management
  • Advanced Demonstrated analytical and Facilitation skills
  •  Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace
  • Ability to convert related activities into a comprehensive work plan
  • Advanced Other Financial skills
  • Advanced Other Knowledge of CMS and state regulations