University of Utah Health Care

Returning Candidate?

Director, Provider Network

Director, Provider Network

Requisition Number 
27635
Reg/Temp 
Regular
Employment Type 
Full-Time
Shift 
Day
Work Schedule 
Days
Location Name 
University of Utah Health Plans
Patient Care? 
..
City 
Murray
State 
UT
Department 
UIP CST 01H UUHP PROVIDER SRVC
Category 
Insurance / Health Plans

More information about this job

Overview

As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

The Provider Network Director provides management, evaluation and oversight of all University of Utah Health Plans’ provider network operations and functions, including but not limited to network configuration, provider contracting and analysis, provider relations, and credentialing activities. This position reports directly to the Senior Director, Provider Network & Business Development and is responsible for organizing and implementing all aspects of the assigned team’s operational initiatives, internal and external customer service, budgetary, human resource and financial management functions. The incumbent should be well versed in managed care contracting and provider relations functions with excellent execution and team development skills.

Responsibilities

  • in collaboration with the Senior Director of Provider Network and Business Development, leads and directs provider relations and network management activities including, but not limited to, provider data management, network configurations, provider agreements, fee schedule analysis and reimbursement strategies that align with UUHP objectives and principles and meet competitive standards. Periodically assists in contract negotiations.
  • Ensures provider relations, credentialing and contracting activities are managed in compliance with various regulatory agencies including State, Federal and accreditation bodies such as NCQA.
  • Executes network configuration consistent with organization strategy and objectives.
  • Seek to negotiate and obtain competitive and best possible wholesale pricing in contracts.
  • Develops and promotes continuous process improvements in assigned area(s).
  • Manages the hiring, orientation, recognition, training and development of staff including but not limited to on-time appraisals, employee evaluations, coaching and disciplinary processes. Upholds PROMISE standards of direct reports and team members.
  • Responsible for developing, monitoring, and achieving budget goals.
  • Responsible to achieve quality goals for assigned area(s).
  • Forms positive relationships with customers, staff, peers, and senior leadership to support the mission, values, and performance standards of the organization.
  • Actively engages staff with updates and news as well as involving staff in decisions and work teams. Provides feedback and recognition when appropriate.

Knowledge / Skills / Abilities

  • Knowledge of principles and processes of hospital, physician and managed care billing practices and reimbursement methodologies.
  • Demonstrated skills in contract negotiations including difficult and complex negotiations.
  • Ability to establish credibility and develop collaborative relationships with hospitals, physicians, and ancillary providers.
  • Ability to supervise, train and mentor staff and communicate effectively with staff, management, executives, and physicians.
  • Strong organization, time management and project management skills and multi-tasking abilities.
  • Advanced analytical skills and problem-solving skills with the ability to formulate and communicate recommendations for improvement.
  • Knowledge and application of English grammar including composition, editing and proofreading skills.
  • Knowledge of and experience with Medicaid and Medicare insurance programs preferred.
  • Ability to work effectively, independently, and as part of a team.
  • Computer skills (including Excel, Word).

Qualifications

Qualifications

Required

  • Bachelor’s degree in Healthcare Administration, Business Administration, or related area.
  • Six years of related healthcare experience in provider or payer relations, provider or payer reimbursement, and/or managed care contracting.
  • Previous management experience.

Qualifications (Preferred)

Preferred

  • Master's Degree in related area.
  • Eight years of experience in provider relations and contracting with accountability for business results.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

  • This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Sitting, Standing