Director, Provider Relations(Must Live in Ohio)

Job Summary:

The Director, Health Partner Engagement directs, oversees, and manages strong relationships with key Health Partners throughout the state to ensure CareSource delivers and meets the specifications of our Health Partner contractors.

Essential Functions:

• Identifies and fosters communications with Health Partners to reduce high cost utilization trends; possesses a strong financial acumen to ensure Health Partner contract financial targets are met and/or exceeded
• Works with Health Partner stakeholders to evaluate policy and process changes for potential impacts, monitors implementation of key initiatives, and provides leadership on key initiatives affecting Health Partners
• Manages Health Partner Relations team that conducts research into Health Partner issues and drives them to completion for the Health Partner network
• Actively engages Health Partner associations and Health Partners to identify opportunities to strengthen relationships and identify collaboration opportunities
• Accountable to lead Health Partner Relations team that promotes achievement of Quality measures and withhold targets with Health partners; works with Health Partners to educate on HEDIS & CAHPS measures and facilitates process of measures data collection for all lines of business 
• Consults with Health Partner Contracting leadership to assist in the development and execution of negotiation plans; lead and/or assist with negotiations as agreed upon with Contracting leadership
• Effectively leads the Health Partner Relations team, including specialists, analysts, and regional concierge, and health partner managers as evidenced by Health Partner, internal customer and client satisfaction, compliance with internal, client, regulatory and accreditation standards, successful audits, and employee satisfaction and engagement
• Directs Health Partner Relations staff to assure day-to-day activities are performed effectively and support the market’s network strategy, including meeting financial targets
• In collaboration with Network Management Leadership, executes on a process improvement strategy which identifies Health Partner satisfaction impacts and root cause of issues to achieve shorter Health Partner inquiry response times, improved employee engagement, and higher Health Partner satisfaction
• Ensures CareSource complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards and participates in market audits
• Provides education, leadership, analysis and ongoing support in the areas of Cost of Care, Value-Based Reimbursement, and cost saving initiatives for the Health Partner relations team and the Health Partner Network
• Understands change management, translates goals and objectives into practical integrated solutions, and delivers on financial value to the Health Partner and CareSource 
• Responsible for the development and communication of performance improvement measurements, working with the Health Partner developing  to develop strategies for success
• Responsible for working cross functionally to assure health partner communications and portal messaging is consistent and provides best in class direction for our health partners
• Provides regional leadership to cross functional teams while coordinating services and support to achieve all market goals set forth by the Market
• Responsible for hiring, managing and ongoing training of the Health partner relations team, providing leadership and coaching to staff on strategy, best practices and professional development and developing and maintaining high team engagement
• Development and management of an annual budget  
• Perform any other job related instructions, as requested

Education and Experience:

• Bachelor’s degree or equivalent years of relevant work experience is preferred
• Master’s degree is preferred
• Minimum of seven (7) years of health plan/managed care experience is required, with at least three (3) years of leadership experience preferred

Competencies, Knowledge and Skills:

• Comfortable working with diverse organizations and in facilitating solutions to competing priorities and interests while maintaining a balance among stakeholders’ needs
• Demonstrated leadership experience, knowledge of managed care best practices, experience driving strategic partnerships and operational improvements, and excellent communication skills
• Expert collaborator adept at maintaining and fostering relationships with Health Partners and key stakeholders
• Is well versed and up to date in Medicaid, Medicare and Marketplace program managed care regulations for the market 
• Strong verbal and written communication skills
• Leadership capabilities in a diverse, multifaceted,