Company: American Association of Integrated Healthcare Deli
Location: Fountain Valley
Posted on: January 8, 2022
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Jobs Job Title Location Search Results: 593 Jobs Save Agent
Loading... Please wait. Director, Provider Management MemorialCare
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wait. Save Job Director, Provider Management MemorialCare Health
System Details Posted: 07-Sep-21Location: Fountain Valley,
CaliforniaSalary: OpenCategories: Operations Internal Number:
MEM005036 Position Summary The Senior Director provides leadership
and direction for the successful operations and effective network
development that integrate the goals of MemorialCare Medical
Foundations (MCMF) Strategic initiatives and other activities for
the areas of Network Development, Provider Contracting and Provider
Relations for all MCMF entities - including GNP and EMG, MCMF
Contracted Specialists; Provider Relations only MCMG Providers; UC
Irvine Health IPA; UC Irvine Health MSO when requested; in addition
to any new entities brought into MCMF This position is responsible
for overall Provider Contract Administration including maintaining
a Contract Management System to effectively manage contracts
including new provider contracts, renewal processing and
renegotiations, and any ACO Contract Maintenance in support of an
ACO department. This position is accountable for monitoring network
adequacy, alignment of necessary specialties and ensuring access to
necessary medical specialties including tertiary services. The
position is accountable for Provider Relations which includes a
team of provider representatives, directory maintenance, event
management, communication plans including department goals that
include but are not limited to excellent service to our providers
and clients, through the use of portals, education seminars,
provider office visits, and various means of provider
communications. Additional accountabilities include monitoring and
oversight of the provider data integrity, and employee engagement.
This position focuses on process improvement and strategies to
increase effectiveness including LEAN initiatives, utilizing
technology, people and standard work. Principal Duties and
- Responsible for the strategic planning and management of MCMF's
contract negotiations, documentation and relationship management
including ensuring network physician/providers are adequately
trained and satisfied with working with applicable entities.
Advises and provides guidance to other emerging Memorial markets on
contracting standards, which may include contract template review
and input to senior management on recommended strategies, as well
as involvement in specific negotiations and documentation.
- Collaborates with other departments to develop assessment and
communication tools to monitor performance of the agreements and
other information critical to the organization and oversee the
review, negotiation, implementation and maintenance of capitation
and fee for service contracts and related materials consistent with
organization's strategic goals, business and marketing plans.
- Oversees the proper set-up and inclusion of the various
products within each Health Plan and the maintenance of Health Plan
websites/rosters to ensure timely and accurate information of MCMF
- Responsible for leading the department teams to increase
effectiveness and implement strategies for department in order to
improve relations with outside network providers and internal
- Directs the contracting and provider relations staff. Oversees
the day-to-day productivity of the department and provide
leadership and guidance to Managers with interviewing, hiring,
evaluations, training, staff development, employee engagement and
resolution of issues.
- Responsible for preparing and adherence to department
- Oversees or provides direction of all Managed Care portal
related business functionality including understanding and
providing guidance with workflow issues particularly in the area of
referrals. Ensures that staff are working with IS Department to
improve Managed Care provider portal functionality and overall
- Oversees or provides direction on analysis of performance of
provider contracts and collaborates with executive management on
opportunities for lowering the cost of providing medical services
using contractual relationships.
- Keeps informed on new provider compensation strategies or
methodologies such as capitation, bundled payments, and pay for
performance opportunities or other means of compensation incentives
to engage providers with MemorialCare strategies.
- Collaborate with management and staff from other departments to
develop standard processes, resolve issues and further the business
goals of the company.
- Collaborates with IT on contract maintenance issues ensuring
fee schedules are updated in conformance with contract requirements
including consulting with MemorialCare IT Epic Tapestry subject
matter experts on implementation of new contractual terms.
- Advise senior management on provider network strategies
(develops, executes and maintains) to meet the needs and goals of
physician groups and Hospitals.
- Oversee the negotiation and renegotiation of provider contracts
and letters of agreement.
- Ensure data integrity in the EPIC managed care system in
regards to provider pricing and provider demographics.
- Oversee provider inquires as it relates to contract/claims
issues and works with providers and office staff to ensure claims
are paid according to contractual terms.
- Works in concert with medical management and marketing to
develop strategies to meet market growth and medical cost
- Perform any additional/miscellaneous duties (not inclusive of
job description) as requested by management team and within scope
of knowledge/ability. Create a Job Alert for Similar Jobs About
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Keywords: American Association of Integrated Healthcare Deli, Fountain Valley , Senior Director, Executive , Fountain Valley, California
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