Description Purpose: The Director of Provider Relations is responsible for managing all aspects of the Network Management/Provider Relations operations including managing the network expansion and development process, Provider Relations workflow development and monitoring, and oversight of all operational aspects of Provider Relations. The Director is responsible for maintaining operations consistent with corporate policies and procedures for Network Management and Provider Relations. Collaboration with Senior Director and other managers within Network is expected to assure appropriate and efficient process within the Department. The Director also represents the organization to the general public and to member groups and participates in overall organizational management as warranted. Responsibilities: Recruits and trains Network Management staff; supervises Network Managers, and conducts performance reviews as required by organization policies. Collaborates with Regional Director and Senior Director to evaluate and implement operational procedures for various network expansion activities. Assists staff in aiding members, providers, prospective members and other departments with information concerning benefits and coverage. Maintains understanding of claims processing issues and assures that department staff are current on covered benefits, limitations, exclusions, policies and procedures, computer screens and code definitions, and maintains current awareness of Plan changes and developments. Serves as contact for UPMC Health Plan commercial, Medicare and CHIP issues, including network expansion activities. Monitors departmental performance against NCQA, DHS and other appropriate internal and external standards; consults with Project Coordinator or other staff, as needed, in this function. `Develops training based on the outcome of the performance monitoring. Establishes expectations for Network Management and Provider Relations activities in conjunction with Senior Director, Network Relations; establishes Team assignments and allocates resources as needed to meet service objectives. Functions with Senior Director and Director Network Management as key departmental representatives in development of network in new service delivery areas. Assists with coordinating information and making presentations to participating providers, state and federal agencies, community groups and other interested parties. Works with Member Services and Quality Management staff to assure that systematic revisions to improve services are developed and implemented; provides leadership from the Provider Relations function in development and implementation of unique services. Qualifications Advanceddegree in a human services or business preferred. Threeyears of customer service experience in human services, health or insurancefield. Threeto five years of supervisory experience in health or human services, at leastone of which is in a customer service area. Generalknowledge of best practices in health and human services, emphasizing work withspecial needs populations and in public sector systems. Generalknowledge of managed care functional areas, including terms and definitions. Independentproblem solving based on sophisticated knowledge of the provider network,Network Management policies, members' rights and responsibilities, and theoperating practices of the organization. Abilityto propose and implement creative solutions to member problems and to achieve ahigh level of member satisfaction with services. Excellentwritten and oral communication skills. Responsivenessto deadlines and has work completed on or before deadline 95% of the time. Licensure, Certifications, and Clearances: UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities REQNUMBER: 36860583 Associated topics: ad, cmo, endowment, event, marketplace, medical center, principle gift, solicitation, stewardship, university relationship
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.