Responsibilities
The Director of Provider Engagement will be responsible for :
- Lead the Provider Engagement team under the Vice President of Provider Network Operations
- Develop and execute strategies to enhance alignment and performance with key providers
- Drive market-level projects to optimize quality, risk adjustment, utilization management, financial performance, and membership growth
- Build strategic partnerships aligned with business goals through Provider Engagement functions management
- Create and formalize Provider Engagement strategy, including Quarterly Business Review (QBR) processes
- Analyze provider group performance data to identify improvement opportunities and focus areas
- Collaborate cross-functionally with Quality Management, Risk Adjustment, Clinical Services, and Sales to monitor and enhance performance trends
- Align partnership goals with providers' business strategies, ensuring mutual understanding and shared objectives
- Conduct Quarterly Business Reviews (QBR) covering financial, quality, utilization, and membership metrics
- Generate executive-level monthly reports on Provider Engagement activities, performance, and goal progress
- Maintain monthly executive reports highlighting key provider performance metrics and initiative progress
Qualifications :
- Associate's Degree required; Bachelor's degree or equivalent combination of education, training, and a minimum of 10 years of relevant healthcare industry experience in provider network management and value-based environments
- 5-7 years of relevant healthcare industry experience in provider network management and value-based environments
- Strong background in managed care, preferably with experience in network management and value-based roles
- Excellent healthcare and financial data analysis skills required
- Knowledge of IPAs, large provider groups, hospital systems, and diverse communities necessary for targeting providers serving various demographics
- Ability to interpret contractual language and effectively communicate messages to clients and customers through written and verbal communication
- Experience in facilitating and / or negotiating contractual arrangements
Desired Skills :
- Master of Public Administration (MPA) or Master of Public Health (MPH) degree
- Supervisory or team management experience
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