Director Provider Relations

***This position is work from home within California.

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

***This position is work from home within California.

Position Summary:

The Director of Provider Relations is a business-minded leader who is able to cultivate, build and maintain relationships with healthcare providers, provide thought leadership and innovation and support sustained growth.
Provides strategic direction and tactical leadership to ensure provider experience, will provide direction as it relates to communication and interactions with providers. This will include direct oversight of the Provider Relations department, which includes the management, and mentorship of the Provider Relations representative team, oversight of provider relations as a whole for Dignity Health MSO, which includes network education, front line provider communication, issue resolution and expansion of networks.
The Director will have a collaborative relationship with the clinical executive leader(s) and ensure there is a consistent partnership to design, drive and execute on the provider relations approach/vision. Provide consistent communication to executive leadership to improve our business model with providers, which will encourage the improvement of health for our patients.

Responsibilities may include:
- Responsible for developing the Provider Experience Model for the organization, which includes consistent provider communication, engagement strategy across multiple markets.
- Accountable for the daily maintenance of strategic provider relationships and other community based providers.
- Ensure physician engagement, retention and satisfaction with Dignity Health MSO provider policies and programs; with a consistent proactive approach.
- Drive, lead and coordinate criteria to improve the interactions between the providers who serve our members and the organization.
- Work closely with provider organizations on administrative and clinical data to simplify the sharing of this information across the Health plan and the provider.
- Document and follow up on issues identified through on-site provider visits, which may include provider disputes, provider call inquiries, claims issues, and/or UM issues.
- Collaborate closely with Dignity Health MSO and CSH/Dignity Health’s marketing/communications channels to leverage multiple channels of communication to ensure timely and accurate provider data – web page, email, video, faxes, in-person.
- Partner closely with Operations Leadership to ensure interactions with all internal Dignity Health MSO operations such as enrollment, claims operations and provider contracting departments is engaged on a consistent basis. Partner closely with Dignity Health MSO clinical executives in developing and driving the Provider Experience Model and execution of outcomes.
- Build and drive quantifiable metrics to measure and monitor success of the Provider Experience Model.
- Establish and maintain positive business relationships, negotiate favorably, collaborate with others, and build consensus both externally and internally to achieve desired results.
- Liaison and instruct Provider Relations Representatives to ensure that proactive engagements are being shared and reviewed (i.e. Know to Share/Provider Profiles, Summary Plan Descriptions, Benefit Summaries, internal operations workflows, and our claims policies and procedures.)

Minimum Qualifications:

- 5+ years of healthcare management, network development, and/or provider/payer contracting, finance, or administration experience in a large healthcare organization or health plan or managed care environment.
- Bachelor’s Degree in business administration and/or 5 years’ experience in a related field in lieu of education.

Preferred Qualifications:

- 10+ years of healthcare management, network development, or provider/payer contracting, finance, or administration experience in a large healthcare organization or health plan or managed care environment preferred.
- Previous senior management experience including responsibilities for hiring, training, assigning work and managing performance of staff preferred.
- Master’s degree in business administration, healthcare administration or related field preferred.

#LI-DH