Director, Provider Network

Responsibilities

Under the direction of the SVP Provider Strategy and Network Management, this role manages the development and sustainability of the affiliate health provider network. Responsible for sourcing and the introduction of InnovAge PACE to the provider community. Works in collaboration with primary care, center operations, and operations leadership to identify and contract with community affiliate providers to meet the complex needs of the InnovAge PACE participants. This position will collaborate with the InnovAge legal team to coordinate contracting and credentialing activities. The Director, Provider Network is responsible for contracting, provider education, and provider relations support of all providers to include inpatient and outpatient clinical and support services and interventional supports. In addition, the Director, Provider Network provides provider and operational support to ensure compliance with contracted terms, access, and availability.

Essential Functions and Work Responsibilities

Functional Category: Provider Network Management

Estimated Percent of time Spent - 100%

• Responsible for identifying provider targets initiating/finalizing provider contracts through the InnovAge contracting process.
• Supports the Network team as the subject matter expert when applicable for large health systems and multi-specialty group practices and organizations.
• Build and develop strong face to face and virtual relationships within the provider community to ensure that effective partnerships are in place to meet the needs of the organization and its participants.
• Works in collaboration with the Primary Care Team, Center Ofperations, and the Interdisciplinary Teams to identify gaps in the provider network.
• Responsible for conducting provider in-services and educating network providers on the InnovAge PACE model of care and processes.
• Responsible for utilizing InnovAge PACE approved materials that are in compliance with state, CMS and any other regulatory agency.
• Responsible for communicating and updating providers on any changes in practice or process in collaboration with the Interdisciplinary Team and the department SVP.
• Conducts face to face provider service visits.
• Provide the department SVP with their strategy approach to close access to care gaps through analysis of the provider network's effectiveness and accessibility.
• Under the direction of the SVP Provider Strategy and Network Management assist in addressing provider related issues including but not limited to provider and participant grievance and appeals, claims, communication barriers and any other related provider relation concerns in a timely and a professional manner.

Travel Requirements

Travel

• Travel required
• Overnight travel out of state

Relocation

• Must be open to relocation based on business necessity

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

REQUIRED

Education

• Bachelor's degree from an accredited college or university in an appropriate discipline; e.g., Business, Healthcare Administration, Public Health

Work Experience and Qualifications

• A minimum of 8 years' experience with network development and management.
• Complex contracting and provider relations experience is required.
• Experience directing provider network contracting, process and service is essential.
• Experience with managed care contracting and provider relations
• Previous experience with Medicare and Medicaid is preferred

Other Knowledge Skills and Abilities Required

Computer Skills

• Must be computer proficient and possess experience with Microsoft Word, Excel, and Outlook and other Office products.
• Must be able to quickly learn specific software and new applications.

Mathematical/Financial Skills

• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Able to analyze data and statistics and draw reasonable conclusions and compile accurate reports.
• Experience with P/L and developing and managing medical cost initiatives.

Language Skills

• Ability to read, analyze and interpret regulations and other documents.
• Strong interpersonal skills and ability to effectively and tactfully present information to, and communicate with, co-workers, employees, and others.
• Possess exceptional English written and verbal communication skills, including accurate grammar and business correspondence knowledge.
• Ability to read and write memos, reports, and correspondence that conform to prescribed style and format.

Reasoning Ability

• Ability to define problems, collects data, establish facts, and draw valid conclusions.
• Intense intellectual curiosity and ability to view old problems with a fresh perspective

Other Skills and Abilities:

• Exceptional critical thinking ability to effectively adapt to changing business needs and manage uncertainty and competing priorities
• Comfortable with ambiguity; working for an evolving organization where there isn't always clarity about what should be done next; must solved thorough coordination with the broader organization and deploy consistent solutions across all markets.
• Able to establish and maintain cooperative, positive working relationships.
• Effective at influencing others to achieve objectives even when not in their direct control
• Organized, detail-oriented, good listening skills, proactive, self motivated, dependable, and trustworthy.
• Even-tempered and able to balance multiple tasks in accordance with changing deadlines and priorities in a fast-paced environment.
• Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds.
• Excellent management ability combined with the skills to effectively represent the program to participants, families, outside agencies, community groups and the general public.
• Knowledge of utilization review, quality assurance and managed health care concepts

InnovAge Service Standards Requirements

Safety

• Safety- Maintains a safe work place. Reports all unsafe work conditions to supervisor and/or Safety & Loss Control Manager and works in conjunction with supervisor, Safety & Loss Control Manager, and staff to correct unsafe work conditions. Follows and enforces all safety policies.

Accountability

• Commitment - Commits to his/her job and to the success of the company. Continuously puts forth the effort to achieve goals and continuous quality improvement. Degree to which employee goes the extra step to ensure job/task completion. Takes initiative to offer ideas to improve processes or results.
• Cooperativeness - Consistently supports management decisions as demonstrated by his/her actions. Demonstrates a "can do" attitude by responding positively to instructions. Follows instructions and works harmoniously with others to complete the job or task.
• Attendance - Meets or exceeds punctuality and attendance expectations/requirements. Faithfully reports to work and conforms to scheduled work hours. When necessitated, follows call-in procedures and informs others of absences.

Caring

• Customer Service - Embraces the organization's commitment to internal and external customer service and demonstrates a customer-centric approach when interacting with co-workers, participants, clients, and all other business contacts.
• Confidentiality - Maintains confidentiality of employee, participant, and client data/information, and any other sensitive organization information as appropriate.

Integrity

• Adherence to Company Policy - Follows and enforces guidelines as established by policies. Conforms to company and job standards and requirements. Shows respect for others. Acts in the best interests of the company at all times. Serves as an example for others. Conducts business in an ethical fashion.
• Reliability - Completes responsibilities with minimal direct supervision. Follows through with assigned jobs and tasks all the way through completion. Puts forth the effort to achieve goals and objectives under varying circumstances.
• Alignment with Company Goals & Objectives - Supports the organization's mission, vision, and values and holding self-accountable for applying these principles daily and personally living them when working with co-workers, participants, clients, and all other business contacts.

Quality

• Quantity of Work / Productivity - Produces at a high volume. Always puts forth the effort to maximize productivity. Meets or exceeds established work deadlines. Engages in a productive work effort whenever possible. Meets goals and objectives.
• Quality of Work - Produces work that is accurate and reliable. Accomplishes work quickly and efficiently. Works in a thorough and organized manner while minimizing down time. Results are consistently within acceptable quality standards.
• Job Knowledge - Demonstrates a thorough understanding of his/her job processes and procedures. Integrates knowledge to efficiently accomplish job requirements. Efficiently uses resources (including staff and management) to obtain additional knowledge.
• Communication - Exhibits good interpersonal skills. Develops and fosters professional relationships with co-workers, participants, clients, and vendors. Keeps others informed as directed by operational demands and need-to-know. Keeps self informed of announcement made via established company venues

Physical Demands /Work Environment

PHYSICAL DEMANDS

Must possess mobility to work in a standard office setting, or clinical setting, and use standard office equipment, including a computer, and medical equipment; vision (close distance, long distance, depth and peripheral) to assess emergency situations, including medical incidents and to read printed materials and a computer screen; and hearing and speech to communicate in person, before groups, and over the telephone. Depending on assignment, standing in work areas and walking between work areas may be required, and travel to visit various cultural, physical, behavioral and environmental settings may be required. Finger dexterity is needed to access, enter, and retrieve data using a computer keyboard, typewriter keyboard, or calculator and to operate standard office and medical equipment. Positions in this classification occasionally bend, stoop, kneel, reach, push, and pull drawers open and closed. Reasonable accommodations will be made for individuals on a case-by-case basis.

WORKING CONDITIONS

Employees primarily work in an office environment with moderate noise levels and fluctuating indoor temperatures. Employees may work outdoors and are occasionally exposed to loud noise levels and cold and/or hot temperatures. Incumbents may be exposed to blood and body fluids while working in a Center. Employees may interact with members of the public or with staff under emotionally stressful conditions while interpreting and enforcing departmental policies and procedures.

STRESS FACTORS

May require working under stressful conditions with pressure to meet scheduled deadlines. There may be distractions such as phone calls, work interruptions, and communication from co-workers and participants with the need to respond and intervene appropriately to multiple interruptions.

Benefits

InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.

InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.

Applicants are considered until the position is filled.

Posted Salary Range

USD $136,440.00 - USD $141,760.00 /Yr.