Job Closed
This listing is no longer active.
Director, Provider Relations
Location
Arizona
Posted
122 days ago
Salary
$113.1K - $209.1K / year
Seniority
Lead
Job Description
Director, Provider Relations
Centene Corporation Group
• Oversee the Provider Relations department including negotiations and administering organization policies and procedures • Oversee the Provider Relations department to ensure in compliance with company policies and standards, government laws, regulations and contracting standards • Develop, implement and monitor policies and procedures • Develop tactical plans to align strategies and technologies with future needs • Effectively manage budget and all resources for short and long-term needs • Prepare and analyze reports on departmental and organizational activities and recommend improvements • Ensure timely Provider set up processing, auditing and distribution of Provider Relations data management • Create effective organizational structure and develop staff skills and competencies • Develop and oversee the training program for the Provider Relations Department
Job Requirements
- Bachelor’s degree in a Business Administration, Healthcare Administration, related field or equivalent experience
- 7+ years of provider relations or contracting experience in a managed care or insurance environment, preferably in Medicare or Medicaid
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff
- Valid driver's license
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Related Guides
Related Categories
Related Job Pages
More Director Jobs
• Establish and maintain effective relationships with customers (internal and external) by determining the customers’ business requirements and looking for new ways to provide value to the customers. • Support Corporate Development efforts related to Sales and Implementation. Analyze Pre-Engagement Reports, providing an Executive Summary with key findings and detailing opportunities for intervention. Provide pricing analysis as needed. • Receive, record and assign all requests. Translate the customers’ business needs into data/systems requirements. Prioritize and manage concurrent projects in order to meet deadlines and ensure customer satisfaction. • Direct and administer the compilation, analysis, validation and dissemination of healthcare information to the customer. Perform data validation and process verification to ensure accuracy and appropriateness of reported information. Ensure documentation of all reports and analyses. • Assist with the preservation and continuous development of an accurate Data Warehouse. Ensure the integrity of data extracts used in reporting and analysis functions. • Conceptualize, design and validate reports to meet routine identified needs. Ensure data is methodologically and statistically sound and that reporting is meaningful and accurate. Work with IT to automate reports. • Perform complex data extractions and manipulations, which culminate in the design and production of meaningful ad-hoc analyses and/or reports as needed. • Identify methodologies to determine variances that are statistically significant for over- and under-utilization. • Develop methodologies for the creation of benchmarks. • Establish and ensure compliance with departmental policies, procedures and standard methodologies. • Perform other duties as assigned.
Director, Associate Managing Partner – IT Strategy Consulting, High-Tech Providers
GartnerWe deliver actionable, objective insight that drives smarter decisions and stronger performance.
• Advise clients at the highest strategic level on both big-picture and tactical matters • Collaborate with Expert Partners and Managing Partners to bring the best solutions to clients • Support Gartner Consulting’s relationship with a defined portfolio of clients • Help clients optimize their IT performance by guiding them towards the right strategic decisions
• Functioning as the key point of contact for US and Global product teams, participating in all relevant product meetings and ensuring that other Market Access functions are involved and present as appropriate • Developing an integrated 3- to 5-year Market Access product plan, which includes integration of short- and long-term access strategies in an annual Brand Planning processes • Engaging with the Integrating Marketing and Customer Engagement Organizations to ensure that we are working efficiently, and market access strategies are seamlessly executed upon • Partnering with Market Access Acct Management and Pricing & Channel Strategy to ensure that annual forecasts are accurate and reflect the latest market events • Socializing US market access product strategies as appropriate with US and Global Product Leads and Executive Leadership • Partnering with brand and other Market Access teams to secure annual budgets and ensure tactical plans support the Market Access product strategies • Working closely and engaging with Legal, Compliance, Brand and Marketing teams to ensure tactics are aligned and implemented in an expeditious and compliant manner • Oversee development of critical market research including development of qualitative and quantitative areas of study, and determining fundamental go-to-market principles to achieve optimal product commercialization • Manage vendor RFP process and ensuring contracting compliance. Responsible for managing multiple budgets and deliverables, including organizing interim project read-outs to ensure cross-functional alignment and ensuring deliverables do not exceed allocated budget
• Verify healthcare software architecture for stability, interoperability, portability, and scalability • Develop system architecture, software architecture, system integration, and distributed system architectures • Design integrated computer systems and develop application-specific software • Collaborate with clients, engineers, and software developers to select appropriate solution designs • Provide expert advice on the US healthcare domain, project costs, design concepts, or changes • Develop or approve project plans, schedules, or budgets • Direct requirement analysis, development, and operations of software development engagements • Identify healthcare system data flow patterns, business logic, compliance requirements • Document design specifications, installation instructions, and system-related information • Support ongoing software development and evaluate existing systems for effectiveness



