Director of Provider Services, South San Francisco, CA
Director of Provider Services
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Director of Provider Services reporting to the Deputy Chief Executive Officer. The Director of Provider Services will lead the strategic development and management of HPSM’s provider network. Main duties include conducting and overseeing provider contracting and payment, with an emphasis on developing and administering value-based payment models and pay-for-performance programs; attracting and retaining a broad network of providers; achieving high provider satisfaction; and continually improving internal processes to better support the provider network.
The essential duties and responsibilities will include the following:
- Develop strategic and tactical plans to align network capacity and performance with organizational initiatives and goals, which include high provider satisfaction, value-based payment, access to care for members, and high performance quality scores.
- Perform capacity analyses for future needs, including consideration of utilization trends and accessibility standards.
- Create an effective organizational structure and develop staff skills and competencies for Provider Services, and develop strategic direction and goal-setting with department staff.
- Develop and implement innovative payment models and provider support services that address the Triple Aim of member experience, health outcomes, and financial sustainability.
- Oversee the Provider Services Department to ensure compliance with company policies and standards, government laws and regulations, and contracting standards.
- Accountability for provider contracting process, including appropriate legal and financial analysis as needed for hospital, primary care providers, specialties and ancillary providers, long term care providers, and home and community based services.
- Ensure that contract language and network adequacy is compliant with state and federal requirements, working in collaboration with other departments, especially Compliance.
- Develop, implement, and either directly or through staff manage delegated risk contracts with eligible entities, and analyze effectiveness over time.
- Oversee Credentialing process to ensure adherence to state and federal laws and regulations.
- Oversee the content and development of informative newsletters and website content for our provider network.
- Oversee provider customer service function, including continually improving online capabilities, to ensure a high level of service and timely resolution of identified problems.
Education and Experience: Bachelor’s degree in business administration, health care administration or related field; a Master’s degree is preferred. Five years contracting and network development/management experience in a managed care setting (HMO, IPA/Medical Group or equivalent).
Knowledge of: Principles and operations of managed care, specifically related to health plan operations, health care providers and networks. Principles of contract negotiations. Legal and regulatory compliance for a managed care organization. Medicare and Medi-Cal programs.
Ability to: Assume a leadership role in the continuous development of the provider services program and gain the cooperation of internal staff and external providers, customers, and community interests. Understand, analyze, and make sound recommendations/implementations based on complex regulations. Serve as a resource to others on relevant laws and regulations. Implement, monitor, and maintain provider program procedures. Manage program areas and a group of staff performing a variety of tasks.
Compensation & Benefits
Starting Compensation Range: $118,896 to $157,537 DOE
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, STD, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more. Check out our full benefits package at: https://www.hpsm.org/abouthpsm/employment-opportunities.aspx (Under Employee Benefits Tab)
How to Apply
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: email@example.com or via fax: (650) 616-8039. File by: Continuous until filled. EOE