Company Statement
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Director, Provider Relations
- Educates and enhances relationships with the provider community. Plans, coordinates and directs Provider Relations service functions. Prioritizes frequency of the provider education visits with the Provider Relations Staff. Develops and coaches Provider Relations Managers and Representatives.
- Contracts with physicians and practitioners for all PPO and HMO lines of business including government programs. Oversees contracting of all pathologists, anesthesiologist, radiologist and ER physician groups.
- Asses financial impact of contractual rates and recommends rate corridors. Negotiates and contracts with IPA’s, Faculty Practice Plans, and large group practices throughout NYS.
- Implements programs to influence and modify practitioner behavior in conjunction with Medical Management team.
- Sets strategic objectives to meet Sales and subscriber needs for network growth and access.
- Directs departmental activity to ensure compliance with all regulatory and organizational requirements and standards. Monitors network accessibility to ensure NYS Department of Health compliance. Ensures compliance with Article 44/49, NCQA and NYS Department of Health network adequacy. Oversee quarterly and annual NYS Department of Health HPN submission.
- Coordinates and oversees all provider communications to include updates to Provider Manual, support Provider Directory publication process and quarterly Provider Newsletter.
- Oversees preparation of monthly executive management reports, sales proposals, and disruptions. Sets business unit priorities and manages departmental resources within budget. Establishes effective departmental practices and works closely with Credentialing, Provider Operations, Actuarial, Sales, Account Services, Claims Operations and IT to assure accuracy of contract implementation and provider satisfaction.
- Bachelor’s Degree required
- Master’s Degree preferred
- Minimum of 10 years of relevant job experience required
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.