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Member and Provider Relations Director

Company: Prime Healthcare
Location: Ontario
Posted on: November 18, 2022

Job Description:

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nations leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!Director Essential Duties and Responsibilities:

  • Strengthens relationships with providers and members.
  • Leads all aspects of Provider Relations to include provider relations and operations to support provider service, provider education, and health plan.
  • Demonstrates an in-depth knowledge of the provider network.
  • Leads, develops, and trains staff to educate key individuals in provider groups regarding new approaches, reimbursement methodologies, appropriate coding and where to submit claims.
  • Creates efficiencies for offices decreasing the administrative obstacles and assists in developing educational programs for internal staff, members and providers.
  • Ensures effective and timely provider and member communication, education and resolution of provider concerns:
  • Ensures assigned provider offices have frequent and regular interactions with the Provider Relations Team.
  • Identifies provider issues and follow to resolution.
  • Coordinates timely responses for provider issues involving referrals, prior authorizations, claims and contracting rate issues in collaboration with the health plan.
  • Conducts periodic office surveys on effectiveness of provider communications and surveys with HR on effectiveness of member communications
  • Assist health plan Marketing department with provider-specific marketing initiatives.
  • Develops and implements a community outreach strategy with network providers including a communication plan to keep them informed of current issues.
  • Develops strong relationships with outside partners, such as vendors and advisors, as well as internal partners, including department supervisors and co-executives.
  • Responsible for Provider Relations Team in managing strong working relationships with all providers; this may include in-office visits and out-of-office meetings with providers.
  • Develops innovative initiatives to enhance internal efficiency and effectiveness.
  • Formulates training programs for the Provider Relations Team.
  • Maintains efficient team structure and performance through analytics, processes and tools; maximizing new provider and member engagement; and working with the leadership team to develop plans to meet future needs.
  • Manages Provider Relations and Representatives and redirects activities as necessary.Qualifications/Skills:
    • Bachelors degree or equivalent experience in Business Administration, Healthcare Administration, or related field. MBA/MHA preferred. 5+ years of experience in customer service and provider relations in a health care or managed care environment.
    • Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
    • Strong interpersonal and collaborative skills.
    • Demonstrated experience and knowledge of contracting requirements.
    • Experience working in a consensus building and matrix environments a plus.
    • Previous health plan and provider representative experience preferred.We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: https://www.eeoc.gov/sites/default/files/migratedfiles/employers/posterscreenreaderoptimized.pdfName: Prime Healthcare Management Inc ID: 2022-103445 External Company URL: primehealthcare.com Street: 3480 E. Guasti Road Shift: Days Exempt / Non-Exempt: Exempt

Keywords: Prime Healthcare, Ontario , Member and Provider Relations Director, Executive , Ontario, California

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