Provider Network Director jobs in Bowling Green, KY

The Provider Network Director is responsible for the full range of provider engagement and adequacy strategies. The Provider Network Director will design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. This role will oversee and seek to improve and simplify end-to-end provider experience including service interactions, appeals and complaints, and general relationship status. Responsibilities also include directing and implementing strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims. The Provider Network Director will spend time connecting with providers directly, both virtually and in person, and assimilating and analyzing data to gain better visibility into provider experience.

This position must operate within Kentucky.

• Manage provider complaints to resolution when initiated through regulators including, but not limited to DMS, DOI, or Legislators. Report status updates to DMS and providers, as needed. Implement solutions that educate network on how to resolve issues with UHC resources
• Proactively partner with providers to identify opportunities for improvement, opportunities for growth and collaboration, and to gain general feedback regarding provider experience
• Partner with Director of Operations to investigate and solve operational challenges. Report status updates to DMS and providers, as needed. Maintain consultative and collaborative approach with providers through resolution
• Engage in onsite visits with providers. Utilize data analysis to determine the best strategy to choose which providers should be visited. Factors may include complaints, claim volume, attribution, quality measures, overlap with other teams, etc.
• Manage regulatory reports for the KY network. Partner with technical and functional teams to compile and audit reports
• Manage Appeals & Grievance Analyst, which includes coaching, mentorship, collaboration, auditing and monitoring, establishing development and career planning, and more
• At least monthly, facilitate meetings with all provider-facing teams including, but not limited to provider relations, network contracting, growth, quality, and subcontractor provider teams
• Attend key provider conferences including DMS Provider Forums, KPCA Provider Conferences, KHA Provider Conferences, etc.
• Show leadership with subcontractors who manage provider networks, including dental and vision
• Lead and facilitate meetings with providers and provider groups including KHA and other provider meetings where regulators are present. Attend and contribute to other virtual provider meetings including KPCA collaboration meetings
• Attend assigned TAC meetings and contribute to the conversation showing leadership and subject matter expertise about our provider experience
• Partner with other provider teams to build expertise and relationships including credentialing, contracting, provider education, PDAD, etc.
• Partner with providers In the adoption of enterprise tools that reduce administration, including but not limited to POCA (Point of Care Authorizations)
• Monitor Provider NPS with a focus on improvement
• Oversee provider communications, including the following:
  
  • Manage annual update and publication of provider manual
  • Participate in quarterly provider newsletter production
  • Conduct provider website review monthly and partner with web teams for updates as needed
• Attend Call Calibration sessions to better understand provider experience and provide coaching and guidance to customer service team to improve the experience
• Be a subject matter expert regarding contract obligations relating to network
• Meet with DMS and other regulatory points of contact, as needed. Focus on relationship building, maintaining awareness and transparency, and making progress
• Consistently monitor network adequacy through Geo-Access reports and partner with UHN and other network teams to fill network gaps
• Partner with Enrollee Services Director to solicit member feedback around provider experience and network gaps
• Drive Health Equity initiatives and SDoH goals within the network of providers
• Partner with UHC and other functional areas on Value Based Contracting opportunities
• Represent UHC in in-person provider meetings, DMS Provider Forums, and other Provider Related conferences, which will require the ability to travel within KY at least 25% of the time

• 5 years of Provider Network Experience
• 3 years of Government Insurance Program Experience* Medicaid, DSNP, Medicare, etc.
• 3 years of experience managing multiple projects
• 3 years of experience with direct communication with Regulators
• Demonstrated ability to establish and achieve a Provider network adequacy and engagement strategy
• Intermediate level of proficiency with MS Word, Excel, and PowerPoint
• Understanding of Medicaid contracting process, including downstream agreements
• Proven ability to establish and monitor key performance indicators
• Proven ability to meet deadlines
• Proven ability to influence course of action when other teams are directly accountable for outcomes

Preferred Qualifications:

• Experience with Compliance Audits
• Advanced reporting techniques (SQL, PowerBI, etc.)
• Proven excellent organizational skills

• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy