Director, Provider Network
PacificSource

Malta, Montana

This job has expired.


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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Oversee provider contracting, provider service, provider partnerships, provider network development, and strategic initiative deployment in assigned territory for PacificSource Health Plans. Direct the reimbursement strategy, collaborating with Actuarial, Analytics and Finance to meet financial targets. Work with senior leadership in Health Services, Finance, Sales and Government Programs to develop key strategies with maximum positive impact. Deploy resources and oversee key work processes to achieve critical goal attainment across all lines of business including commercial, Medicare and Medicaid. Manage adherence to government regulations for provider-related requirements and develop relationships, as appropriate, with regulatory agency representatives. Work collaboratively with senior leadership in Finance, Operations, Analytics, Sales, IT, Health Services, Revenue, Government Programs, and across teams in Provider Network - as well as external contracted vendors, and external provider partners.

Essential Responsibilities:

  • Manage network development processes with key provider partners in conjunction with constituents within PacificSource including health care exchange leaders, government sales and marketing, commercial sales, and product development staff.
  • Manage key provider partnerships whether created as part of strategic provider partners, CCO collaborations, aligned risk models, or through mutually agreed upon value-based payment agreements.
  • Manage contracting processes of IPAs, physicians, hospitals and other providers, including risk models, fee-for-service reimbursement, value-based payment methodologies, and aligned incentive models with provider partners.
  • Manage provider relations activities including workshops, provider transactional support, responsiveness to provider inquiries, strategic activity deployment, including EHR access, 5-star enhancements, clinical enhancement deployment (MyCare visits), medical record access, transactional efficiency, provider communications, policy deployment, Provider Manual activities, and other activities of key strategic importance between PacificSource and its external provider network.
  • Ensure network adequacy and marketability, collaborating with Product leadership to manage targets.
  • Manage processes with staff and leaders in intradepartmental activities such as compliance activities, fee schedule implementation, managing phone queue, internal audit activities, credentialing activities, policy formation and project management.
  • Manage vendor relations and activities to meet department goals. Develop and implement business plan to replace vendor activities using internal staff, where possible.
  • Responsible for positive departmental culture as it relates to opportunities for improvements in prior department engagement and culture survey results.
  • Responsible for oversight, management, development, implementation, and communication of department programs and activities.
  • Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-one meetings and performance evaluations for direct reports.
  • Develop annual department budgets. Monitor spending versus the planned budget throughout the year and take corrective action where needed.
  • Actively participate as a key team member in Manager/Supervisor meetings, as well as PRISM walks and other key department activities. Actively participate in committees as appropriate and in conjunction with other department leaders.
  • Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
  • Interact with staff in internal departments such as Finance, Revenue, Health Services, Sales, Communications, IT, Analytics, Government Programs and Compliance. Coordinate business activities by maintaining collaborative partnerships with key departments.

Supporting Responsibilities:
  • Assess new and innovative provider payment methodologies for approval and implementation.
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: At least 7 years in healthcare or closely related fields required. Demonstrated ability to develop and execute strategy. Proven negotiation or business experience.

Education, Certificates, Licenses: BA or BS in business, health care administration, finance, or equivalent combination of education and experience required. Master's degree preferred.

Knowledge: Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities in relevant markets and geography.

Competencies

Authenticity

Building Organizational Talent

Empowerment/Delegation

Coaching and Developing Others

Customer Focus

Emotional Intelligence

Operational Decision Making

Compelling Communications

Managing Conflict

Passion for Results

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 15% of the time.

Skills:
Accountable leadership, Business & financial acumen, Empowerment, Influential Communications, Situational Leadership, Strategic Planning

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.


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