Director, Provider Relations and Contracting

Evolent Health   •  

Fort Myers, FL

Industry: Healthcare

  •  

Less than 5 years

Posted 158 days ago

This job is no longer available.

What You’ll Be Doing:

The Director, Provider Network Development role will oversee the development and operational management of provider networks that serve the members of Evolent’s clients’ population health offerings in the delivery of high quality, cost-effective care.

The role reports to the Senior Director, Network Development and will require close alignment with Evolent Clients’ network management staff members, outsourced network development vendors, local Evolent Client Service Delivery, Evolent Information Technology and UPMC.

Responsibilities:

  • Oversee differentiating operational processes for network development, provider file configuration, fee schedule maintenance, and management of ongoing provider networks in partnership with clients, Evolent Client Service Delivery teams and UPMC
  • Oversee market-specific network development vendor s to assure contracting goals are met. Contracting goals include recruiting cost effective, strategically aligned clinical networks that meet CMS adequacy requirements and client marketability requirements.
  • Coordinate network development and ongoing network management with UPMC operational leadership to ensure operational/IT coordination of network related TPA services.
  • Assure network development vendor, understands and effectively contracts a provider network with compensation methodologies that support high quality, cost effective care and alignment with client strategic interests and local care management programs
  • Oversee the development and maintenance of high quality provider files that support accurate and timely claims payment, utilization and care management, credentialing and other network management functions
  • Coordinate the maintenance of contracttemplates and other specific agreements to supportnetwork goals and regulatory compliance
  • Work with client service delivery teams to define a provider education model and develop reports for ongoing provider education and improvement opportunities.
  • Work closely with Client Provider Relations team to counsel and develop staff to effectively build professional local market relationships with physicians, hospitals and ancillary providers.
  • Coordinate the development and maintenance of provider communications materials with Evolent Communications Department, mail vendors, network development vendors, Client provider relations leadership and Evolent website developers
  • Develop applicable operating policies and procedures within the Network Development department at Evolent and support client development of their internal provider network operational policies and procedures.
  • Other duties as assigned.

The Experience You’ll Need (Required):

  • Degree in business, healthcare, finance, or related field
  • 4 years experience in a managed care setting with provider relations and provider contracting experience.
  • Experience presenting financial and clinical trend reports to physicians and physician practice leadership
  • Excellent verbal and written communication skills, analytical and organizational skills are required
  • Presentation experience and experienceworking with physicians and provider office staff