United States onlyWhat are important things that YOU need to know about this role?
• Seeking an experienced leader who understands dental/vision care delivery and has demonstrated the ability to drive team performance while successfully delivering results.
• Prior experience managing networks in the Medicare/Medicaid space is required.
• Work location can be remote in the U.S. or in person in our Menomonee Falls, WI location (near Milwaukee).
What will YOU be doing for us? Manage the field provider relations team in providing a world class provider experience by creating and maintaining high performing provider networks, developing and deploying provider relations staff and strategic initiatives. Develop and oversee provider outreach programs, the collection of provider feedback, escalated issues and serve as the voice of the provider within SKYGEN to advance organizational objectives.
What will YOU be working on?
• Oversee Field Provider Relations team ensuring systems, plans and accountabilities are in place for conducting provider office visits, education and resolution of escalated issues.
• Develop and monitor statistics to monitor provider usage of systems as well as individual performance. Use metrics to suggest new programs or manage performance appropriately.
• Review and approve provider training materials to ensure accuracy and thoroughness.
• Assist in resolving complaints and issues for clients, providers, and internal staff.
• Act as resource for difficult or escalated provider calls and coordinate with internal resources to provide a resolution.
• Work collaboratively on any proactive calling project by ensuring available resources and appropriate training.
• Maintain up to date knowledge of all client requirements and communicating appropriately to staff to result in proper internal processes that meet all obligations.
• Ensure staff is appropriately trained on new markets to be able to successfully perform their roles.
• Develop and implement methods of training and cross training staff on product lines.
• Work effectively and collaboratively with peers and other internal resources in diagnosing and resolving issues.
• Work collaboratively directly with clients and the SKYGEN Client Experience team to develop and deliver strategic market focused provider management programs aimed at increasing provider satisfaction and reducing program costs.
• Assist in the ongoing evaluation of policies and procedures and assist in development and implementation of new efficiencies based on assessments.
• Identify, develop and implement best practices to ensure improved efficiency, cost effectiveness, and that contractual requirements are met and/or exceeded.
• Complete weekly, monthly, quarterly, annual and ad-hoc reports.
• Update manager on significant provider complaints, issues and contract requirements.
• Act as expert in the area of Provider Relations and aid in answering Request for Proposal (RFP) questions, assists in client audits, and organize any necessary quality audits.
• Engage in strategic and tactical planning positioning the Provider Relations team as the experts in the provider experience and voice of the provider within the organization.
• Work closely with providers and Field Representatives to coordinate and lead Provider Advisory Board meetings.
• Oversee the administration of provider satisfaction surveys and deliver client facing annual survey results.
• Develop and oversee the administration of training and quality assurance programs focused on creating a world class provider experience.
• Responsible for developing and managing to the approved budget.
• Foster an environment of continuous improvement though process and systematic efficiencies.
What qualifications do YOU need to have to be GOOD candidate?
• Bachelor’s degree in Business or related field.
• 5 -7 years of experience in a health care setting.
• 5+ years of experience in a management capacity.
• Prior experience managing networks.
- Knowledge of standard dental, vision and/or other health care terminology.
• Ability to manage multiple priorities and ensure timelines and deadlines are met.
• Ability to successfully lead teams and develop/retain talent.
• Ability to work with a diverse group of internal and external customers.
• Display strong communication skills both in person and in written documents.
• Ability to build and maintain work relationships and contacts needed to effectively address issues and obstacles.
• Demonstrated ability to make appropriate decisions when faced with conflicting information or needs.
• Ability to travel 20%-25% of the time.
What qualifications do YOU need to have to be GREAT candidate?
• Master’s degree in Business Administration or similar field.
• 7-10 years of experience in health care or insurance administration.
• More than 5 years of experience in a management capacity.
• Prior experience managing networks in multiple states/markets.
• Experience developing and implementing training and quality assurance programs.
• Experience in managing through change efforts.
• Knowledge of Enterprise System.
The salary range is listed for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.
