Commonwealth Care Alliance Job Details: Director of Provider Relations in Charlestown, Massachusetts

Job Details: Director of Provider Relations

On-Line Application

  • Vacancy NoVN2366

Posting TitleDirector of Provider Relations

Location CityCharlestown

Language Requirement

Job Description

Director, Provider Relations

The Director of Provider Relations is responsible for leading a team of provider relations representatives to effectively service the needs of the provider community. Responsibilities include provider education, communication, documentation and service recover. Working closely with Claims, Contracting, Clinical and other CCA departments, this position will have the opportunity to set the strategic direction for the department and CCA.

Primary Responsibilities

  • Complete oversight of daily operations and strategic planning for future provider relations needs

  • Identifies operational performance metrics, develops dashboards for department and staff that enable data driven decisions

  • Serves as a point of escalation for complex provider issue management, root cause assessment and resolution

  • Facilitates resolution of member grievances involving providers and/or provider services.

  • Develops and implements provider education in support of continuing provider service relationships

  • Develops and manages the department budget; controls expenses while meeting performance requirements

  • cross-functional stakeholder collaboration on initiatives and policies impacting providers

  • Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.

  • Develops and implements an effective communication strategy that meets regulatory and contractual requirements

  • Gain, align and act on market intelligence from provider community

  • Responsible for provider engagement/satisfaction measures, improvement and reporting

  • Honor commitments consistent with organization and department’s vision, behave ethically and act with integrity, and communicate with candor

  • Perform additional duties and projects as assigned by management

Minimum Experience Required

  • 5-7 years relevant experience

  • Bachelor's Degree required, Master's Degree preferred

Knowledge, Skills and Abilities

  • Proven experience in a people management leadership position

  • Influencing skills

  • Experience working in a managed care organization

  • Thorough understanding of managed care/Medicare/Medicaid plan operations

  • Ability to develop and deliver effective presentations to all levels of the organization including executives

  • Experience setting and leading strategies within the provider community

  • Excellent knowledge of MS Office; specifically program/project management software (MS Project etc.)

  • Outstanding leadership and organizational skills

  • Excellent communication skills

  • Excellent problem-solving ability

  • Strong business acumen, and strong knowledge of health care delivery system

  • Capacity to lead, develop, transform and execute strategy

  • Track record of communicating effectively across the organization

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable).

Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.

CCA is committed to protecting the health of our workforce and our members, and we encourage flu vaccination in accordance with CDC recommendations. Individuals working in clinical care areas or in direct contact with members must provide documentation of flu vaccination, or wear a mask during flu season whenever engaged in member-facing activities.