Director, Health Partner Engagement

This is a fully remote position, open to applicants in United States.

📋 Description

• Direct and manage relationships with essential Health Partners across the state.

• Identify and enhance communication with Health Partners to mitigate high-cost utilization trends and achieve contractual financial objectives.

• Assess policy and process modifications, oversee the implementation of initiatives, and provide leadership on initiatives impacting Health Partners.

• Supervise the Health Partner Relations team and ensure the resolution of Health Partner issues.

• Collaborate with Health Partner associations and stakeholders to strengthen relationships and discover collaboration opportunities.

• Spearhead efforts to meet Quality measures and withhold targets; educate Health Partners on HEDIS and CAHPS metrics and facilitate data collection.

• Aid in the development and execution of negotiation strategies and lead or support negotiations alongside Contracting leadership.

• Manage Health Partner Relations staff to ensure effective daily operations that align with network strategy and financial goals.

• Implement process enhancement strategies to boost inquiry response times, employee engagement, and Health Partner satisfaction.

• Guarantee adherence to regulatory compliance, accreditation standards, and successful market audit participation.

• Provide education, leadership, analysis, and support concerning Cost of Care, Value-Based Reimbursement, and cost-saving initiatives.

• Transform goals and objectives into actionable integrated solutions that deliver financial value to Health Partners and CareSource.

• Create and communicate performance improvement metrics and strategies.

• Ensure consistent communication with Health Partners and maintain portal messaging.

• Offer regional leadership to cross-functional teams to achieve market objectives.

• Recruit, manage, train, mentor, and develop the Health Partner Relations team.

• Develop and manage the annual budget.

• Execute other job-related tasks as assigned.

⛳️ Requirements

• A Bachelor’s degree or equivalent relevant work experience is preferred.

• A Master’s degree is preferred.

• A minimum of seven (7) years of experience in health plan/managed care is required.

• At least three (3) years of preferred leadership experience.

• Proven leadership experience and understanding of managed care best practices.

• Experience in driving strategic partnerships and operational enhancements.

• Knowledge of Medicaid, Medicare, and Marketplace program managed care regulations.

• Excellent verbal and written communication skills.

• Strong management, budgetary, and operational skills.

• Comprehensive understanding of the administrative, technical, and clinical aspects of health care.

• A valid driver’s license, car, and insurance are necessary for work-related travel.

• Successful clearance of a driver’s license record check is required.

• An annual Influenza vaccination is mandatory for designated positions during Influenza season.

• Ability to travel more than 50% of the time.

• Capability to work in a general office environment and utilize standard office equipment.

🏝️ Benefits

• Bonus opportunities tied to both company and individual performance may be available.

• A comprehensive total rewards package is offered.

• Support for Influenza vaccination requirements and vaccination records.

• Reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs.

• Flexible working hours, including possible evenings and/or weekends as required.

• An equal opportunity workplace focused on belonging.