Director of Provider Network, Tacoma, WA
PacificSource is anything but a typical health plan. We’re a growing, independent, not-for-profit organization with an 85-year history and reputation for service excellence. At PacificSource it is our 950+ employees that make a difference. We invest in the communities we serve by partnering with local providers to deliver high quality, accessible healthcare, and through charitable giving and personal involvement with non-profit organizations. Join us in our mission of helping people get the healthcare they need and let your work make a difference, too. We offer excellent benefits, competitive wages, and opportunities for growth and promotion.
Benefits: PacificSource provides excellent benefits to ensure the well being of employees and their dependents. Employer-paid benefits include medical, vision and dental insurance, incentive program, paid time off and holidays, 401k plan, training and education opportunities, life insurance and additional voluntary programs including a flexible spending account.
Position Overview: Oversee provider contracting, provider relations, provider partnerships, provider network development, and strategic initiative deployment in assigned territory for PacificSource Health Plans. Work with senior leadership in Health Services, Finance, Sales and Government Programs to develop key strategies with maximum positive impact. Deploy resources and oversee key work processes to achieve critical goal attainment across all lines of business including commercial, Medicare and Medicaid. Work collaboratively with senior leadership in Finance, Operations, AUA, Sales, IT, Health Services, Revenue ,Government Programs, and across teams in Provider Network – as well as external contracted vendors, and external provider partners.
- Manage contracting processes of IPAs, physicians, hospitals and other providers, including risk models, fee-for-service reimbursement, innovative payment methodologies, and aligned incentive models with provider partners.
- Manage network development processes with key provider partners in conjunction with constituents within PacificSource including health care exchange leaders, government sales and marketing, commercial sales, and product development staff.
- Manage provider relations activities including workshops, provider transactional support, responsiveness to provider inquiries, strategic activity deployment, including EHR access, 5-star enhancements, clinical enhancement deployment (MyCare visits), medical record access, transactional efficiency, provider communications, policy deployment, Provider Manual activities, and other activities of key strategic importance between PacificSource and its external provider network.
- Manage key provider partnerships whether created as part of CCO collaborations, aligned risk models, or through mutually agreed upon partnership agreements.
- Manage processes with staff and leaders in intradepartmental activities such as compliance activities, fee schedule implementation, managing phone queue, internal audit activities, credentialing activities, policy formation and project management.
- Manage vendor relations and activities to meet department goals. Develop and implement business plan to replace vendor activities using internal staff, where possible.
- Responsible for positive departmental culture as it relates to opportunities for improvements in prior department engagement and culture survey results.
- Responsible for oversight, management, development, implementation, and communication of department programs and activities.
- Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-one meetings and performance evaluations for direct reports.
- Develop annual department budgets. Monitor spending versus the planned budget throughout the year and take corrective action where needed.
- Actively participate as a key team member in Manager/Supervisor meetings, as well as PRISM walks and other key department activities. Actively participate in committees as appropriate and in conjunction with other department leaders.
- Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
Work Experience: At least 5 years in healthcare and 3 years in provider contracting, provider relations, or provider network operations required.
Education, Certificates, Licenses: Bachelor’s Degree in related field required.
Knowledge: Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities in relevant markets and geography.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
For more information on this or other positions and to complete a required application, please visit us online at www.pacificsource.com/careers.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.