Senior Director - Provider Relations - ValueOptions - Orange County

Job description

We are currently seeking a dynamic Senior Director National Provider Relations to join our team at our office in Cypress, CA. The Senior Director National Provider Relations will be responsible for managing the operations of regional provider relations departments to include provider relations functions in all assigned service centers, including provider network management and development, provider education and training, provider communications and maintenance of network composition to ensure access and availability. Supports implementation of national provider relations initiatives to include planning, directing, organizing and evaluating the implementation of strategic plans that will ensure consistency across regional operations in assigned scope and effective collaboration with national and regional departments.

Position Responsibilities:
Participates with national networks and provider relations leadership in the development, presentation, implementation and communication of strategic plans, policies and procedures to ensure the provider relations units under span and scope meet established regional and national goals with the identified time and budgetary requirements.
Coordinates with peer National Provider Relations Director(s) to ensure effective collaboration, process improvement, and consistent practices both within and across geographic regions.
Oversees geographical access analysis to identify gaps in the provider network, opportunities for recruitment, and assures coordination of efforts across regions to assure standards are met.
Oversees the development and implementation of recruitment plans in the area of responsibility and assures coordination of efforts across departments and regions to meet network needs.
Participates in managing provider relationships through practitioner and facility orientation and training, attendance at meetings, providing review and feedback of provider performance under contract terms, participation in resolution of complaints and questions, and preventing provider disenrollment as necessary.
Acts as a resource in the development of responses to RFP’s, and may participate in presentations.
Contributes to provider newsletters, the provider handbook, and identification of provider mailings, trainings, and other provider management issues.
May serve as a provider relations departmental lead on implementation teams for new business as assigned.
Communicates regularly with network services and network operations management to share information and ensure accurate and timely response to provider.
Collaborates with the contracting unit to coordinate contracting issues across regions and with network operations.
Participates in regular calls and meetings with other national and regional provider relations management and staff. Attends national credentialing Committee meetings and local provider advisory committee meetings and other internal committees as assigned.
Provides information used in annual budget planning activities and effectively manages the cost of operations to the budget throughout the year.
Performs the interviewing, hiring, training, development and performance management of provider relations staff in the area of responsibility.
Position Requirements:
Education: Bachelor’s degree in human services, health care administration or a related area is required. Master’s degree in human services or a related area is preferred.

Relevant Work Experience: At least five years of progressively responsible and complex management positions in provider relations and/or a combination of managed care, behavioral healthcare, practice management and claims administration.

Knowledge, Skills & Abilities:
Extensive knowledge of managed care environment, network development and network management is required, preferable with a managed behavioral health care organization or HMO.
Excellent communication skills flexibility, adaptability, problem solving capability, creativity, initiative, teamwork skills, prioritization skills and public relations skills are required.
Demonstrated ability to interact and negotiate with mental health, substance abuse, and employee assistance program providers is required.
Strong organizational, communication, analytical, problem solving and staff management and budget management skills are required.
Ability to manage in a geographically disbursed, complex and changing environment.
Strong customer service orientation.

ValueOptions is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.

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