Director, Provider Relations and Medical Networks
Encova Insurance
full-time
Posted on:
Location Type: Remote
Location: Virginia • West Virginia • United States
Visit company websiteExplore more
Salary
💰 $108,812 - $174,099 per year
Job Level
About the role
- Lead a technical team and develop strategies to manage medical expenses within the workers’ compensation program.
- Ensure compliance with regulatory requirements and oversee vendor relationships.
- Implement best practices to deliver quality care while controlling costs.
- Provide leadership through coaching, mentoring, and directing the medical network, provider relations, and medical bill review teams.
- Develop and implement medical cost containment strategies aligned with organizational goals.
- Monitor industry trends and regulatory changes to ensure compliance and optimize performance.
- Manage provider networks, utilization review, bill review, and pharmacy benefit programs.
- Analyze medical cost drivers and identify opportunities for savings.
- Prepare reports and present findings to senior leadership with actionable recommendations.
Requirements
- Bachelor’s degree or equivalent in healthcare administration, business, or related field is required.
- Minimum of 7 years of insurance experience in workers’ compensation or medical cost containment is required.
- Strong knowledge of provider networks, fee schedules, utilization review, and pharmacy management.
- Previous experience in a leadership or management role is strongly desired.
- Demonstrated experience with managed care programs and vendor management is preferred.
- Familiarity with state workers’ compensation regulations and cost strategies is strongly preferred.
Benefits
- Health, Dental & Vision Insurance
- Company-provided life and income protection plans
- Eligibility to participate in a company incentive bonus program
- 401(k) Retirement Plan - 100% company match up to 7% on annual salary
- Paid Time Off, Paid Holidays, and Floating Holidays
- Flexible Work Arrangements - Hybrid and remote depending on the role
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical cost containmentutilization reviewvendor managementprovider networkspharmacy managementfee schedulesdata analysisreport preparationcost strategies
Soft skills
leadershipcoachingmentoringcommunicationstrategic planning
Certifications
Bachelor’s degree in healthcare administrationBachelor’s degree in business