Director, Provider Relations 8/31/2016

Fidelis Care Albany, NY

Company
Fidelis Care
Job Classification
Full Time
Company Ref #
29312586
AJE Ref #
576044841
Location
Albany, NY
Job Type
Regular

JOB DESCRIPTION

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FIDELIS CARE OFFERS QUALITY, AFFORDABLE COVERAGE TO RESIDENTS ACROSS THE STATE OF NEW YORK, INCLUDING PRODUCTS AVAILABLE THROUGH MEDICAID, MEDICARE AND THE NY STATE OF HEALTH. FIDELIS CARE WAS FOUNDED ON THE BELIEF THAT ALL NEW YORKERS SHOULD HAVE ACCESS TO AFFORDABLE, QUALITY HEALTH INSURANCE AND THAT REMAINS OUR MISSION TO THIS DAY TO OUR 1.5 MILLION MEMBERS.

The Director of Provider Relations is responsible for overseeing a regional staff of provider relations representatives and associates responsible for facilitating appropriate provider on-site education, problem resolution, partnership development and ensuring optimum provider satisfaction, compliance with regulatory requirements and achievement of Fidelis Care New York's goals and objectives. The Director also works collaboratively with key regional providers.

KEY RESPONSIBILITIES

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Assure that all provider orientations, site visits, access and availability studies are completed within established timeframes.
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Coordinate partnership meetings to foster strong, positive, collaborative relationships with key providers and to facilitate and strengthen marketing opportunities.
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Coordinate QARR/HEDIS and Medicare record retrieval.
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Oversee QARR/HEDIS and Quality outreach by Provider Services staff.
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Provide access and data reports to providers as needed and address concerns regarding growth opportunities.
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Investigate and resolve provider complaints and member complaints regarding providers to maintain member satisfaction.
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Assist Contract Management in identification of network deficiencies and make recommendations on how to address them.
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Work with Human Resources staff to recruit, interview, select, and hire employees.
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Coach, mentor, and develop staff, including overseeing new employee onboarding and providing career development planning and opportunities.
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Identify staff training needs and provide ongoing training, as well as initial orientation, to ensure the effectiveness of Provider Services staff.
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Provide oversight and direction to employees in accordance with organizational policies and procedures.
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Lead using a performance management and development process that provides an overall context and framework to encourage employee contribution and includes goal setting, feedback, and performance development planning.

REQUIRED EXPERIENCE AND EDUCATION
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5+ years Provider Relations or related experience leading staff to meet departmental and organizational goals.
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BS/BA required, Masters Preferred.
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Proficiency in Microsoft Office.
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Strong analytical and problem solving skills.
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Advanced change management and communication skills.