Director Provider Relations - Jacksonville, United States - Birdsong Hearing Benefits

Description

Overview:

ABOUT US

Your Hearing Network (YHN) is an experienced hearing benefit administrator that partners with health plans, unions, employer groups and affinity programs to provide quality hearing care. Our mission is to provide services to promote health hearing, which will lead to better overall health and wellness.

Your Hearing Network seeks to hire a Director of Provider Relations who will be a key member of the executive team. This position actively participates in the oversight of the provider relations and contracting for hearing health care. The Director provides oversight for development of strategies and processes, direction of staff, and execution of all provider relations and contracting tasks within the scope of the operations unit. Key areas of responsibility include provider relations, network management, and contracting services associated with provider contracting negotiations, preparation of contract review with legal and deployment of key contracting elements, and key performance indicators associated with contract guidelines. The mission of the Director, Provider Relations is to successfully build, manage, and grow network size and adequacy; network satisfaction; member satisfaction; members being served; member engagement targets; and outcomes targets.

Responsibilities:

ESSENTIAL JOB FUNCTIONS

Key Strategy & Execution

Create solutions and enablement capabilities and align them to the requirements and success criteria of each strategic payer relationship

Working with other executives, rapidly refine the operational plan to ensure overachievement of payer-facing metrics.

Interface with strategic payer clients as the relationship manager and "directly responsible individual" (DRI) to ensure the success of the business and the partnership, including driving clear and aligned goals and execution across both parties.

Responsible to recruit, mentor, and inspire others while holding employees accountable to deliver superior performance

Subject matter expert and deep understanding of hearing aid products and services within the Top 5 Leading Global Manufactures, ability to demonstrate knowledge and attributes to current and potential customers through product knowledge and conversations.

Manage cross-functionally across network operations to ensure organization exceeds expectations including:

Network Operations

Network Contracting and Engagement. Matrixed management of customer success and marketing operations to build, maintain and nurture our networks of customer base to support our payer clients

Network Performance Management. Manage the networks to ensure creation and sustained broad network with strong capability to support payer contracts

Network Performance Management. Manage the networks to communicate, support, and enforce standards and ensure world-class member satisfaction.

Network Management

Interfacing directly with provider/other executive sponsors as the executive relationship manager, directly responsible individual (DRI) and program manager to ensure the success of the business and the partnership, including driving clear and aligned goals and execution across both parties

Managing relationships with executive payer/provider/ and key client team members at all required levels in the organization

Owning and driving the agenda

Presenting executive presentations and monthly / quarterly communications to Client executive sponsors including CEO, COO, CFO, CMO, etc.

Looking around the corner to predict client needs, head off issues, and proactively implement plans and actions to mitigate

Achieving / exceeding target program outcomes; manage reporting

Managing cross-functionally internally across network operations to ensure organization exceeds expectations of the strategic programs including:

Network Management and Communication. Manage communications and operational requirements to support strategic partners, all network customers to ensure world-class customer satisfaction.

Contracting: Track and support the delivery of the Network Strategic partner-facing support operations, including metrics reporting, escalation management and experience optimization

Key Accountability Metrics

Executes strategic initiatives within given timeframes.

Relationship oversight of all current and potential networks.

Serves as a liaison between network relationships and network partners, Sales, and other operational teams within network.

Provide superior, professional, ongoing, consistent communication and service with designated networks and clients, to maintain a positive, long-term relationships.

Subject matter expert / point person for network related questions and clarifications.

Detailed review, negotiation, editing and sign-off, in coordination with COO and President of Managed Care, of all new and renewing network contracts.

Development, maintenance, and management of a successful provider network.

Manages oversight of analysis and implementation of new and existing networks to validate network need, adequacy, and competitive market rates.

Ensure consistent and thorough review of network legal and compliance updates, in coordination with COO, legal, Compliance Officer and President.

Handle daily network, client, and internal requests, overseeing until resolved.

Proactively resolve network specific issues and needs.

Successful oversight of all network tracking spreadsheets for purposes of maintaining network information, requirements, adequacy, contract changes and pricing.

Manages network projects and initiatives as business needs dictate.

Coordinates network reporting such as, but not limited to, geo access, disruption, and claims analysis reports upon request.

Ensure network is administered within full network guidelines and within the abilities of Key requirements including SLAs.

Oversee elevated network issues to resolution.

Be available for occasional network/client related travel as needed.

Meets annual budget expectations.

PROFESSIONAL EXPERIENCE/QuALIFICATIONS

Requirements and Must Have Criteria

Leadership and Strategy: We are looking for a leader, first and foremost, who is strategic, inspirational, can drive sustainable change and who can deliver results. The person must have at least 5-7 years of experience with demonstrated success of network management responsibility leading provider relations & contracting efforts for other TPAs, health plans or provider networks.

Proven Track Record Delivering Operational Excellence and Value to Customers: Proven ability to effectively manage end-to-end provider relations & contracting growth and retention is vital. Understanding the voice of the customer is essential to success. The person must be data-driven and analytical in nature. Experience using process-improvement tools such as Lean (Kanban preferred) and Six Sigma is highly preferred.

Deep Healthcare/Health Plan/TPA with Preferred Hearing Aid Domain Expertise: Mission-oriented and energetic, the person must have a demonstrated track record of success in the US healthcare sector with a passion for evidence-based care. The successful candidate needs to possess experience in the healthcare industry with providers, payers, drug, device, and/or diagnostic manufacturers, with supplemental benefit understanding. Seasoned experience in all Lines of Business in managed care.

Staff Management and People Development Skills: Proven and successful track record recruiting, mentoring, and inspiring and empowering individuals with an ability to hold people accountable and to deliver superior performance. Excellent emotional intelligence and ability to identify their own strengths and gaps to maximize impact. Demonstrated ability to delegate effectively and to establish clear guidelines for accountability.

Interpersonal, Communication, and Relational Building Skills: Ability to relate to and effectively work with a diverse group of individuals, groups, and people collaboratively and diplomatically. Proven ability to engage internal and external constituencies. The person must possess an uncanny ability to handle and to resolve conflict in a productive and direct manner. Excellent oral and written communications are a must. The person must also exude high energy with a positive manner and a can-do attitude and excellent judgment.

Other Personal Characteristics and Experience

Ability to simultaneously balance and adjust to multiple changing priorities and make decisions with speed and accuracy.

A true team player who takes a collaborative approach with executive peers and other colleagues. Someone who is able and willing to regularly debate constructively, build consensus, and ultimately align around common objectives. A direct communicator who can foster the same among his/her executive level peers.

A strong people leader who is willing and able to apply professional development techniques with direct reports, while always utilizing a cooperative and cross-functional approach.

High level of proficiency and demonstrated effectiveness in problem-solving, and implementing new programs related to increased departmental and organizational operating efficiency.

Successful track record designing, building, and managing complex national enterprise payer relationships lasting a year or more with multiple stakeholders

Ability to move with the speed, agility, and alacrity necessary to create new, foundational capabilities from the ground up

Superb C-suite diplomatic and relationship management skills

Growth mindset Ability to operate with lean resources and be "hands on" as necessary and "do what it takes" to exceed expectations for your teammates, our customers, and our partners

Systems thinking, with operational and process focus and unrelenting attention-to-detail

Experience building a compliant organization in a complex regulatory environment

Impeccable values, ethical standards, and a strong moral compass with integrity.

Experience in hearing aid industry, as an Audiologist or hearing aid technician would be beneficial but not required. Experience in supplemental benefit design and implementation.

5+ years of managed care experience, including Medicaid, Medicare and commercial insurance payer systems that includes health plan level. Strong negotiation skills required.

Experience overseeing provider relations &contracting functions is required with positive outcomes.

Business savvy and financial acumen.

Qualifications:

EDUCATION

Hearing Professional License required: Audiologist or Hearing Instrument Specialist/ Hearing Aid Dealer

Proper education to support 4-year degree and extended education specialized in hearing care preferred. Will consider work experience in lieu of education.

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