Director

• Oversee the development and execution of, as well as provide support and direction to, the Provider Engagement team in support of all products
• Own applicable P&Ps, SOPs, SLAs and ensure compliance with them
• Develop innovative, competitive, cost effective and quality networks for all products in support of new sales and existing client retention
• Champion provider adoption/utilization of digital platforms/tools
• Provide support and direction to the team to ensure appropriate allocation of resources to meet multiple deliverables and participate in a wide range of network focused initiatives
• Establish provider network targets, recruit/contract new providers and work with existing providers to move them along the cost and quality continuum.
• Develop strategies to increase member access, preventive care, increase quality and outcomes, while decreasing costs
• Collaborate with other areas to ensure members assignments and dental home programs meet cost, quality, access and capacity goals
• Review and submit for approval special deal requests, retroactive adjustments, reimbursement, and contract exceptions
• Use available tools and resources to conduct Network Adequacy, Compliance, Validation, Accuracy, Appointment Availability, and other related activities as required/needed
• Collaborate with other enterprise functions to drive improvements in Provider Data Integrity
• Support and assist credentialing to obtain missing credentialing information
• Collaborate with Marketing, Communications, Governmental Relations, Clinical and Client teams to position the organization favorably and achieve desired business results
• Partner in responding to Request for Proposals (RFPs) to illustrate network strategies as a competitive advantage to grow new business and retain existing business
• Strategize with analytics and other teams on best approaches for collection, evaluation, compilation, and dissemination of data consistent with requirements and goals
• Assess environmental trends, needs, and opportunities to inform decision makers internally and externally on opportunities to execute provider programs that achieve annual business goals.
• Monitor portfolio of contract operations ensuring successful execution of operating plan objectives and achievement of outcome/success measures for Providers
• Develop and manage department budgets and resources consistent with short and long term financial and operational goals
• Proactively research competitors’ provider panels; fee schedule and reimbursement methodologies; policies and procedures; tools and technology; processes, etc.; and make recommendations to meet or exceed competition
• Build and maintain relationships with leaders of local dental associations, FQHCs, Public Health, dental schools, large group practices and other key provider stakeholders
• Collaborate with Client team to meet network needs and participate in on-site meetings, virtual meetings, conference calls, and day-to-day interaction with clients, prospective clients, organized dentistry, and other key industry stakeholders
• Direct team on the appropriate preparation of client audits, CAPs, and ad hoc report documents
• Oversee other engagement activities and projects related to the provider network
• Ensure internal and external network reports are prepared and delivered accurately and timely
• Develop solutions to improve participating provider satisfaction and innovative approaches to advance recruitment strategies to attract providers to join all lines of business
• Develop and maintain provider reimbursement models in line with cost of care goals, market research and profitability/loss ratio objectives, using effective negotiating strategies
• Draft Provider Agreements, Restated Agreements, Amendments, and other communications as needed and by working with legal and marketing
• Organize, assess and problem solve workflows with other departments to ensure efficient, timely and accurate outcomes
• Coordinate and implement appropriate performance management strategies for team members to include: Assist in the hiring process, including interviewing candidates
• Assist, train and motivate team members to Evaluate and measure effectiveness of team members
• Assist in preparation of performance and wage evaluations in accordance to company policy
• Responsible for attendance and company approved time off for team members
• Participate in the determination and implementation of Performance Improvement Plans and performance management initiatives.
• Design reports to effectively manage team members
• Train and coach team to be knowledgeable in all aspects of their role and responsibilities
• Other duties as assigned.

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