Director, Provider Relations
- 📁
- Director and Equivalent
- 💼
- EmblemHealth
- 📅
- Sep 26, 2019 Post Date
- 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
Company Statement
Careers at EmblemHealth: For nine decades, EmblemHealth has been making quality health care accessible and affordable for New Yorkers, and helping to make life better in the communities we serve. Our employees are proud of that legacy and want to make health care better for everyone. Here we inspire success while helping employees build meaningful careers. We offer competitive health and welfare benefits, retirement benefits, and incentive pay plans. Join us for a rewarding experience.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
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.
Sponsorship Statement
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, Emblemhealth may provide work visa sponsorship for certain positions.
