Vice President, Provider Relations

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Company: Health Net of California
Location: Glendale, CA

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This role is responsible for leading all aspects of provider services, including building and maintaining strong provider relations with key providers and working closely with various operational areas to support provider services, quality initiatives, network development, data quality initiatives, claim processing and expansion of the markets served by the company. The VP of Provider Services works closely with others to ensure that members have access to best-in-class service providers and that members receive quality care at reasonable costs.

Foster direct collaboration between providers and the health care plan to reduce rework, streamline administration and reduce costs for all constituents.
Collaborate with all functions within the company to develop services and processes that streamline claim adjudication, achieve a high level of compliance and customer satisfaction.
Lead the development of provider related corporate initiatives, business plans, strategies, and goals.
Manage efforts to partner with providers to achieve high quality results consistent with HEDIS measures.
Monitor new trends in provider network, reimbursement and services. Design and implement strategies to capitalize on new trends.
Enhance and leverage analytics, member demographics, and healthcare facility usage patterns to identify efficiency opportunities and target service providers for direct contracts.
Maintain local and state government relationships, including dealing with regulators as necessary to establish and continue effective working relationships.
Attract, recruit and retain the talent Provider Relations needs to achieve its objectives. Provide mentoring and foster a success-oriented and accountable culture.
Coordinate and Communicate annual Provider Satisfaction Survey consistent with NCQA standards.
Collaborate with others on data that impacts provider domain to ensure that provider data is being maintained consistent with internal data governance standards.

Develop & execute workforce development strategies supporting the needs of field teams and provider practices.
Qualifications:

Education/Experience: A Bachelor’s Degree is required, Master’s Degree preferred. Minimum of 15 years experience in senior leader roles in managed care environment at a Healthcare payer organization. Preferred years of experience focused specifically on developing provider networks and building partnerships. Highly developed knowledge of healthcare industry, provider network, claim processing, UM guidelines and health plan operations.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.