Director, Provider Relations & Engagement

Summary of Job

Develop company external-facing, field-based provider network community and practice-level physician engagement strategy, infrastructure, model and accompanying tools to drive success. Oversee provider relations functions, including leading a team of Provider Relations Field Representatives, dedicated to provider education and service, issue resolution, strategic initiatives, and network optimization. Responsible for the execution of best-in-class provider service, working collaboratively with other operational and functional stakeholders to lead or support development of plans and tactics to improve overall experience. Oversee the implementation/communication to providers on products, services, performance programs, policies, and various tools; develop education materials to support implementations. Assist in development of metrics and reporting tools to support engagement, growth, satisfaction, network optimization, quality and cost improvement activities.

Responsibilities

• Establish and lead quality relationships with fee for service and value-based care providers (physicians, groups, FQHCs)
• Develop, implement, and oversee the provider relations/physician engagement model and accompanying tools (i.e.,
  approach, standard practices, workflows, business intelligence and data visualization tools, and scorecards) for Provider Relations Field team effectiveness in delivery of value-add services at physician point of care - education and training, timely and root-cause issue resolution, issue prevention, performance reporting, on-site marketing, provider programming, and growth strategies
• Develop and coordinate targeted provider relations/experience improvement strategies and recommendations across various operational or business areas to address high-friction experiences; translate provider strategies into tactical and accountable plans
• Assist in monitoring and developing high performing practices in quality and coding accuracy; introduce programs, improvement opportunities, and performance scorecards/reporting (gaps in care, documentation & coding, cost and clinical effectiveness)
• In collaboration with key internal business partners, establish measurable plan to lead the development and implementation of advanced and emerging provider partnership models for growth and outcomes
• Attend EmblemHealth and provider community engagement events and conduct field visits with Provider Relations Field Representatives to evolve relationships, build awareness, educate, review performance, and assess capabilities; recommend initiatives to strengthen partnerships, drive network transformation strategies, develop practices, and optimize membership growth, retention and outcomes
• Assemble Joint Operating Committees and/or Joint Workgroups, including structure, processes, documentation and membership; lead collaborative effort with internal cross-functional stakeholders to support provider performance and resolution of complex issues/barriers/challenges
• Ongoing contract maintenance and resolution of business issues associated with contract terms, including disputes, financial settlements, provider reporting, etc.
• Maintain provider field visits calendars and dashboard to ensure adherence to engagement and service levels and achievement of key performance indicators
• Align field team touchpoints to provider engagement metrics and feedback loops, and balance dedicated resources for high-value providers and broader coverage needs
• Monitor and report team success metrics: total visits made, total issues resolved within SLA, on site marketing agreements, leads referred to licensed agents, growth per region, community partnerships established, operational or quality/coding/cost performance, etc.
• Develop processes and practices to ensure assigned providers adhere to EmblemHealth policies and procedures, contract terms, access and availability requirements, data submission requirements for credentialing, NY State Health Provider Network (PNDS) reporting, CMS RAD-V chart audits, and all other regulatory and provider network compliance requirements
• Lead, coach, train, develop, and manage staff to ensure corporate and department goals and objectives are met
• Support and empower team to resolve complex or escalated provider issues.
• Other related tasks/projects as directed, assigned, or required.