Responsibilities

Under the direction of theVice President, Provider Growth and Network Strategy, this role manages the development and sustainability of the community affiliate health provider network. Responsible for sourcing and the introduction of InnovAge PACE to the provider community. Works in collaboration with primary care, center operations, and operations leadership to identify and contract with community affiliate providers to meet the complex needs of the InnovAge PACE participants. This position will collaborate with InnovAge internal teams - Legal (contract documents), Compliance, Finance, Claims, Credentialing, and Provider Data Management - to coordinate related activities. The Director, Provider Network is responsible for contracting, provider education, and provider relations support of all community affiliate health providers to include inpatient and outpatient clinical and support services and interventional supports. In addition, the Director, Provider Network is the central external facing resource who provides provider and operational support to community affiliate health providers to ensure compliance with contracted terms, access, and availability.

Essential Functions and Work Responsibilities

Functional Category: Provider Network Management

Estimated Percent of time Spent 100%

• Responsible for identifying provider targets initiating/finalizing provider contracts through the InnovAge contracting process.
• Supports the Network team as the subject matter expert when applicable for large health systems and multi-specialty group practices and organizations.
• Build and develop strong face to face and virtual relationships within the provider community to ensure that effective partnerships are in place to meet the needs of the organization and its participants.
• Works in collaboration with the Primary Care Team, Center Operations, and the Interdisciplinary Teams to identify gaps in the provider network.
• Responsible for conducting provider in-services and educating network providers on the InnovAge PACE model of care and processes.
• Responsible for utilizing InnovAge PACE approved materials that are in compliance with state, CMS and any other regulatory agency.
• Responsible for communicating and updating providers on any changes in practice or process in collaboration with the Interdisciplinary Team and the department VP.
• Conducts face to face provider service visits.
• Provide the department VP with their strategy approach to close access to care gaps through analysis of the provider networks effectiveness and accessibility.
• Under the direction of the VP Provider Growth and Network Strategy assist in addressing provider related issues including but not limited to provider and participant grievance and appeals, claims payment disputes, delegated credentialing intake tool submissions, recredentialing CVO requests for affiliate community providers, communication barriers, and any other related provider relation concerns in a timely and a professional manner.
• Develop and lead provider network growth strategies that help strengthen our market presence and support enrollment growth across centers.
• Build and grow relationships with physicians, specialists, hospitals, health systems, and community referral sources to drive participant acquisition and retention.
• Identify and pursue new provider partnership opportunities in both current and emerging markets, ensuring expansion efforts support overall growth goals.
• Increase PACE awareness among providers through training, regular outreach, and use of existing provider and participant-facing materials.
• Work closely with Growth, Operations, Clinical, and Market Leadership teams to maximize provider relationships that drive referrals, improve access to care, and support census growth.
• Track provider network performance, referral trends, and market opportunities, and develop targeted plans to increase engagement and referral volume.

Travel Requirements

Travel

• Travel required
• Overnight travel out of state

Relocation

• Must be open to relocation based on business necessity

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

REQUIRED

Education

• Bachelors degree from an accredited college or university in an appropriate discipline; e.g., Business, Healthcare Administration, Public Health

Work Experience and Qualifications

• A minimum of 8 years experience with network development and management.
• Complex contracting and provider relations experience is required.
• Experience directing provider network contracting, process and service is essential.
• Experience with managed care contracting and provider relations
• Previous experience with Medicare and Medicaid is preferred

Other Knowledge Skills and Abilities Required

Computer Skills

• Must be computer proficient and possess experience with Microsoft Word, Excel, and Outlook and other Office products.
• Must be able to quickly learn specific software and new applications.

Mathematical/Financial Skills

• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Able to analyze data and statistics and draw reasonable conclusions and compile accurate reports.
• Experience with P/L and developing and managing medical cost initiatives.

Language Skills

• Ability to read, analyze and interpret regulations and other documents.
• Strong interpersonal skills and ability to effectively and tactfully present information to, and communicate with, co-workers, employees, and others.
• Possess exceptional English written and verbal communication skills, including accurate grammar and business correspondence knowledge.
• Ability to read and write memos, reports, and correspondence that conform to prescribed style and format.

Reasoning Ability

• Ability to define problems, collects data, establish facts, and draw valid conclusions.
• Intense intellectual curiosity and ability to view old problems with a fresh perspective

Other Skills and Abilities:

• Exceptional critical thinking ability to effectively adapt to changing business needs and manage uncertainty and competing priorities
• Comfortable with ambiguity; working for an evolving organization where there isnt always clarity about what should be done next; must solved thorough coordination with the broader organization and deploy consistent solutions across all markets.
• Able to establish and maintain cooperative, positive working relationships.
• Effective at influencing others to achieve objectives even when not in their direct control
• Organized, detail-oriented, good listening skills, proactive, self motivated, dependable, and trustworthy.
• Even-tempered and able to balance multiple tasks in accordance with changing deadlines and priorities in a fast-paced environment.
• Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds.
• Excellent management ability combined with the skills to effectively represent the program to participants, families, outside agencies, community groups and the general public.
• Knowledge of utilization review, quality assurance and managed health care concepts

InnovAge Service Standards Requirements

Safety

• Safety- Maintains a safe work place. Reports all unsafe work conditions to supervisor and/or Safety & Loss Control Manager and works in conjunction with supervisor, Safety & Loss Control Manager, and staff to correct unsafe work conditions. Follows and enforces all safety policies.

Accountability

• Commitment  Commits to his/her job and to the success of the company. Continuously puts forth the effort to achieve goals and continuous quality improvement. Degree to which employee goes the extra step to ensure job/task completion. Takes initiative to offer ideas to improve processes or results.
• Cooperativeness  Consistently supports management decisions as demonstrated by his/her actions. Demonstrates a can do attitude by responding positively to instructions. Follows instructions and works harmoniously with others to complete the job or task.
• Attendance  Meets or exceeds punctuality and attendance expectations/requirements. Faithfully reports to work and conforms to scheduled work hours. When necessitated, follows call-in procedures and informs others of absences.

Caring

• Customer Service - Embraces the organizations commitment to internal and external customer service and demonstrates a customer-centric approach when interacting with co-workers, participants, clients, and all other business contacts.
• Confidentiality  Maintains confidentiality of employee, participant, and client data/information, and any other sensitive organization information as appropriate.

Integrity

• Adherence to Company Policy  Follows and enforces guidelines as established by policies. Conforms to company and job standards and requirements. Shows respect for others. Acts in the best interests of the company at all times. Serves as an example for others. Conducts business in an ethical fashion.
• Reliability  Completes responsibilities with minimal direct supervision. Follows through with assigned jobs and tasks all the way through completion. Puts forth the effort to achieve goals and objectives under varying circumstances.
• Alignment with Company Goals & Objectives  Supports the organizations mission, vision, and values and holding self-accountable for applying these principles daily and personally living them when working with co
  9workers, participants, clients, and all other business contacts.

Quality

• Quantity of Work / Productivity  Produces at a high volume. Always puts forth the effort to maximize productivity. Meets or exceeds established work deadlines. Engages in a productive work effort whenever possible. Meets goals and objectives.
• Quality of Work  Produces work that is accurate and reliable. Accomplishes work quickly and efficiently. Works in a thorough and organized manner while minimizing down time. Results are consistently within acceptable quality standards.
• Job Knowledge  Demonstrates a thorough understanding of his/her job processes and procedures. Integrates knowledge to efficiently accomplish job requirements. Efficiently uses resources (including staff and management) to obtain additional knowledge.
• Communication  Exhibits good interpersonal skills. Develops and fosters professional relationships with co-workers, participants, clients, and vendors. Keeps others informed as directed by operational demands and need-to-know. Keeps self informed of announcement made via established company venues

Physical Demands /Work Environment

PHYSICAL DEMANDS

Must possess mobility to work in a standard office setting, or clinical setting, and use standard office equipment, including a computer, and medical equipment; vision (close distance, long distance, depth and peripheral) to assess emergency situations, including medical incidents and to read printed materials and a computer screen; and hearing and speech to communicate in person, before groups, and over the telephone. Depending on assignment, standing in work areas and walking between work areas may be required, and travel to visit various cultural, physical, behavioral and environmental settings may be required. Finger dexterity is needed to access, enter, and retrieve data using a computer keyboard, typewriter keyboard, or calculator and to operate standard office and medical equipment. Positions in this classification occasionally bend, stoop, kneel, reach, push, and pull drawers open and closed. Reasonable accommodations will be made for individuals on a case-by-case basis.

WORKING CONDITIONS

Employees primarily work in an office environment with moderate noise levels and fluctuating indoor temperatures. Employees may work outdoors and are occasionally exposed to loud noise levels and cold and/or hot temperatures. Incumbents may be exposed to blood and body fluids while working in a Center. Employees may interact with members of the public or with staff under emotionally stressful conditions while interpreting and enforcing departmental policies and procedures.

STRESS FACTORS

May require working under stressful conditions with pressure to meet scheduled deadlines. There may be distractions such as phone calls, work interruptions, and communication from co-workers and participants with the need to respond and intervene appropriately to multiple interruptions.

Benefits