Director, Provider Contracting(Must Live In Nevada)

Job Summary :

The Director, Provider Contracting executes contracting strategy, develops provisions based on cost, quality / analysis and monitors key metrics.

Essential Functions :

• Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting
• Ensure an ongoing high level of staff engagement, empowerment and development
• Responsible for provider recruitment, implementation of contracts
• Responsible of contracts and testing, initiating set-up, post configuration testing, maintenance and audit of claims system
• Create contract language and review with legal to develop approved contract templates
• Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
• Implement an efficient and effective process to on-board new providers; ensure network is adequate (access for members), cost-effective, competitive and stable, and meets corporate & regulatory requirements
• Responsible for ensuring all regulatory requirements for provider network are met
• Perform gap analysis to ensure no gaps and / or sanctions occur; identify & implement solutions that mitigate risk; development of corrective action plans as needed
• Responsible for access grievance intake, analysis and performance improvement initiatives
• Participate in training sessions for providers and staff as appropriate
• Support the contracting requirements of the corporation for geographic regions and products
• Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis
• Assist with development and review of payment policies and provider notifications
• Collaborate with appropriate personnel with process of reassignment of members related to provider terminations, as required by the state
• Perform any other job related instruction as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$132,900.00 - $232,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type : Salary

Competencies :

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

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