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Director of Provider Engagement

Cure the Executive Edge

Director of Provider Engagement

Department: Provider Network Operations
Location: Downtown NYC
Salary Range: $150,000.00 – $155,000.00

 

About Client

Cure Staffing, Inc, DBA Cure the Executive Edge has partnered up with one of NYC’s most prevalent and prestigious insurance providers. Our client provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, and network including primary care providers, specialists and participating clinics. Over the last three decades, our client has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life and we are excited to help them accomplish this goal. We are seeking qualified, appropriately skilled professionals who can provide reliable and professional support. All candidates must have education, experience, licenses, and certifications that are applicable and appropriate to the level of this position.

Position Overview

Reporting to the Vice President of Provider Network Operations, the Director of Provider Engagement will lead the Provider Engagement team and have overall accountability to develop and maximize improved alignment, driving high performance and provide world-class engagement experience with identified key providers. By leading market level projects and strategies for provider engagement, this position will drive optimal performance on quality, risk adjustment, utilization management, financial performance, and membership growth. This team will also serve as the one-stop “Quarterback” for the highest profile groups, including coordinating Quarterly Business Reviews (QBRs) and various operational meetings to drive performance. Success in this role will be measured by aligned goals that include but are not limited to membership growth, quality, risk adjustment, utilization management, and overall financial performance.

Job Description

  • Develop and oversee all Provider Engagement functions including establishing key provider partnerships aligned with the organization’s business goals and setting up QBR meetings.
  • Establish Provider Engagement strategy and action plan, formalizing QBR agenda, content, analytics and aligned goals.
  • Review data and analytics of key provider group performance to determine areas of focus and develop improvement opportunities.
  • Collaborate effectively with internal functions such as Quality Management, Risk Adjustment, Clinical Services, Sales and others to monitor trends and develop strategic plans to improve performance.
  • Demonstrate understanding of providers’ business goals and strategies to facilitate the analysis and align on partnership goals.
  • Establish effective Quarterly Business Reviews (QBR) with a formal agenda that includes but is not limited to financial, quality, utilization, and membership reporting.
  • Develop and maintain Executive level monthly reporting on all Provider Engagement activity, performance, and progress to goals.
  • Develop monthly executive report of key provider performance and activity, including but not limited to progress on goals and initiatives.
  • Fosters a culture of accountability that emphasizes people and performance management, coaching and development and employee engagement.

Minimum Qualifications

  • Master of Public Administration (MPA) or Master of Public Health (MPH) degree required; and
  • 5-7 years of relevant healthcare industry experience in a provider network management and value-based environment; or
  • A satisfactory equivalent combination of education, training, and minimum 10 years of relevant healthcare industry experience in a provider network management and value-based environment.
  • Solid background in healthcare, preferably experience working in a network management and valuebased role required.
  • Must have excellent healthcare and financial data analysis skills.
  • Knowledge of IPAs, large provider groups, hospital systems, and diverse communities required to target providers that serve different demographics.
  • Ability to decipher contractual language and clearly deliver messages to clients and customers with written and verbal communication.
  • Experience facilitating and/or contracting arrangements.

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication
  • Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization, including executive and Clevel.
  • Demonstrated self-starter, strategic thinker, ability to manage complexity and ambiguity
  • Adapt quickly to change in an ever-changing environment.
  • Ability to develop solid long-term positive working relationships.
  • Ability to drive effective change
  • Strong business acumen, analytical, critical thinking, and persuasion skills
  • Proven track of building and cross-functional relationships
  • Demonstrated ability to lead and develop strong, effective teams.

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