Director, Provider Network Management and Payer Relations - University of Rochester

GENERAL PURPOSE: The Director of Network Management and Payer Relations is responsible for developing and executing a network strategy for the recruitment, retention and engagement of a high performing clinical network. He/she is the dedicated network relationship manager, creating and sustaining relationships with providers in order to engage them around AHP’s mission and objectives. The Director develops and executes communications strategies that promote provider quality and cost accountabilities and enhance awareness of the AHP value proposition. Additionally, the Director is the primary point of contact for the operational implementation of payer contracts, and also leads the negotiation of contract terms and benefit plan design for AHP’s current and future direct employer contracts, which are responsible for significant revenue and covered lives for AHP. He/she oversees staff focusing on provider relations and practice facilitation and transformation. As a member of the AHP leadership team, he/she participates in the development of strategies and plans that support organizational objectives. The Director gives counsel and support to the COO on the day-to-day operations of AHP and takes on special projects as necessary. The Director is the subject matter expert on AHP operating agreements, bylaws and participation contracts. **RESPONSIBILITIES:** **Provider Network Management** + Develops and nurtures relationships with prospective and current providers, community partners and business partners; facilitates effective communication with and between stakeholders. + Develops and implements a region-specific network development plan; sets recruitment goals. + Provides ongoing assessment of network to identify gaps and determine adequacy; recommends specialty specific recruitment. Ensures that the primary care capacity is sufficient for effective health care delivery for health plan members. + Implements and manages provider onboarding process that ensures timely contracting and capital contribution payment. + Ensures provider compliance with contracting guidelines. + Evaluates and monitors providers’ performance standards and financial performance of contracts; participates in provider corrective action planning. + Contributes to quality improvement efforts through participation in provider initial assessments and development of practice transformation initiatives. + Collaborates with system stakeholders to identify and obtain resources for providers that enable quality performance success; working with our medical directors to lead development of provider incentive program. + Recommends and implements provider participation criteria and policies. + Implements and maintains applications that maintain the provider data required for contract participation; develops processes for effective CRM data management to satisfy stakeholder reporting needs. + Works with system leadership to resolve provider service and access issues in order to improve in-network referral rates. + Develops and implements provider satisfaction surveys; leverages results to develop improvement strategies. **Payer Relations** + Leads and facilitates the AHP negotiating team in contracting with employer health plans, including executing negotiating strategy, tracking open issues, and maintaining and updating the contract document. Seeks new opportunities for AHP with other employee health plans. + In collaboration with employer plans’ consultants/brokers, recommends tier differentials and gap specialties. + Develops health plan member educational strategies and content. + Works with payers to resolve claims issues; manages employer health plan call center. **Communications Management** + Develops, implements and executes provider and corporate communications strategies. + Leads development and daily maintenance of corporate web site and social media accounts. + Responsible for agenda creation and conduct of provider advisory committees; provides event planning and logistical support for Clinical Grand Rounds. **Other Duties** + Manages the Provider Relations team: develops and oversees the department training program; develops staff skills and competencies; manages department budget. + Assists CEO and COO in devising AHP strategy, and applies that strategy to key decisions and activities related to AHP’s provider network. + Provides frequent activity updates and reports to the Board of Managers; conducts board elections. **QUALIFICATIONS:** + Bachelor's degree in a business administration, healthcare administration, marketing or related field or equivalent experience required. Master’s degree preferred. + 7+ years of provider relations or contracting experience required. Management experience required. Experience in an ACO or insurance environment preferred. **Required:** + Ability to understand the “big picture” goals and objectives of AHP, and to apply that knowledge to day-to-day decision-making and activities. + High level of analytical ability to establish goals and objectives to support success. + Ability to identify, define and apply metrics for a measurement of success. + Action oriented individual with ability to identify opportunities and adapt to change + Ability to works independently, demonstrate good judgement and prioritize tasks and responsibilities. + Possesses detailed knowledge of AHP’s key strategies and a drive and desire to advance AHP’s mission. + Continuously strives to meet and exceed goals. + Strong customer service skills. + Interpersonal skills to include the ability to form constructive and effective relationships with clients and customers and objectively handle conflict management. Attentive and active listening skills. Effective verbal and written communication skills, and strong presentation skills with ability to adjust accordingly for a variety of audiences. + Strategic problem solving with ability to adapt to change and/or uncertainty. + Intellectual ability to handle concepts and complexity comfortably. + Knowledge of regulatory standards, compliance requirements and hospital policies and procedures. + Working knowledge of technology such as word processing, graphics, databases, spreadsheets, etc. + Excellent critical thinking, problem solving, community outreach, relationship building, organizational and communication skills are required. The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations. **How To Apply** All applicants must apply online. _EOE Minorities/Females/Protected Veterans/Disabled_ **Location:** Health Sciences **Full/Part Time:** Full-Time **Opening:** Full Time 40 hours Grade 055 URMC Accountable Care Network **Schedule:** 8 AM-4:30 PM