Commonwealth Care Alliance Job Details: Director of Provider Relations in Charlestown, Massachusetts
Job Details: Director of Provider Relations
- Vacancy NoVN2366
Posting TitleDirector of Provider Relations
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.
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
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.