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  • French Camp, CA 95231

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Director, Provider Relations

Health Plan of San Joaquin • French Camp, CA

Posted 2 months ago

Job Snapshot

Degree - 4 Year Degree
Other Great Industries
Health Care, Management

Job Description

The Director, Provider Services is responsible developing and implementing innovative strategic plans for the care and maintenance of the physician network.  This position is responsible for monitoring and ensuring access to patient care and for overall customer service for HPSJ providers.  This position has direct oversight of the Provider Services team and is responsible for managing and building long-term service relationships with federally qualified health centers (FQHCs), contracted physicians and medical groups in order to support their understanding and compliance with regulatory requirements as well as HPSJ policies and procedures. Work is varied, complex, and requires a high degree of discretion and independent judgement.


  • Provider Services staff

Essential Functions
          Provider Community Support/Engagement:
  • Foster and maintain proactive and positive relationships by communicating with provider offices through face-to-face visits, letters, telephone calls, faxes or emails for the purposes of resolving issues and sharing information; gather information and feedback on issues or concerns related to HPSJ members, providers or healthcare in general
  • Effectively identify, direct, and/or research provider operational issues for timely resolution per HPSJ and state requirements through a thorough knowledge of all areas of HPSJ operations and a strong working relationship with other departments
  • Actively organize/lead or attend key provider and community meetings and events to provide leadership for ongoing provider service support
  • Develop provider training strategies, provide training oversight and direct the development of educational materials for effective operational support
  • Assess the composition of the existing network, the opportunities for expansion in assigned territories and the availability of services in the surrounding communities to provide a comprehensive overview and understanding of the medical community to both internal and external customers.
  • Develop, update and maintain the provider manual.
  • Ensure high level of satisfaction of network providers and lead and implement annual provider satisfaction survey.

Provider Services Staff Development and Supervision
  • Establish and monitor corporate provider services goals and strategies to ensure physician retention, regulatory compliance and support member access to care
  • Provide day-to-day supervision of internal and external Provider Services staff; monitor, evaluate and complete written performance evaluations of direct reports
  • Promotes and maintains, and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and
  • Hire, train, develop, supervise and retain, competent and highly effective staff members.

Interdepartmental Leadership
  • Monitor and thoroughly vet regulatory changes and proactively develop strategies for operations and implementation including coordinating cross-functional discussions and communication
  • Conduct research, respond to inquiries, serve on workgroups and provide direction and guidance to other HPSJ business units on provider related regulatory and operational issues
  • Provide leadership on departmental strategic projects to improve provider access and performance (i.e., provider incentive program development, member engagement, innovative technology solutions, etc.)
  • Develop and maintain policies and procedures to meet strategic goals and ensure regulatory/contractual compliance
  • Contribute to the development of written communications for the provider bulletin, manual, website and other publications and ad hoc reports and letters; Monitor accuracy of provider materials and information on the HPSJ website.
  • Identify and research a variety of issues related to provider, compliance and operational issues utilizing various sources including, but not limited to, current contracts, publications, websites, etc.; report information in an appropriate manner either via reports, letters or verbal communication

Job Requirements

Required Skills
  • In-depth knowledge of the healthcare and managed care industry, its products, services and major business processes
  • In-depth knowledge of the regulatory guidelines governing network development and contracting in a managed care environment
  • In-depth knowledge of the business, economic, demographic and political trends and developments affecting healthcare and managed care in general, and provider network development and operations in particular
  • Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions
  • Very strong assessment and analytical skills, including the ability to synthesize, distill concepts, draw conclusions and identify implications
  • Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems
  • Decision quality: Makes good and timely decisions that keep the organization moving forward
  • Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies; creates, executes and monitors relevant strategic and business
  • Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities
  • Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals
  • Drives results: Consistently achieves results, even under tough circumstances
  • Ensures accountability: Holds self and others accountable to meet commitments
  • Very strong interpersonal skills, including the ability to initiate, establish and maintain effective working relationships with individuals at all levels both inside and outside of
  • Very strong oral and written communication skills, including the ability to communicate professionally, effectively and persuasively both orally and in writing to diverse individuals and groups inside and outside of the organization; includes the ability to effectively explain complex
  • Advanced presentation skills, including but not limited to the ability to tailor presentations to a specific audience, be persuasive and identify key
  • Strong customer service
  • Strong collaboration skills, with demonstrated ability to create and foster a collaborative work environment, maintain effective, high performance teams, and organize people and resources to solve problems and identify
  • Builds networks: Effectively builds formal and informal relationship networks inside and outside of the
  • Strong project management skills, including the ability to manage organizational-wide projects to successful
  • Strong knowledge of change management theory, with ability to anticipate and implement
  • Organizational savvy: Maneuvers comfortably through complex policy, process and people- related organizational
  • Persuades: Uses compelling arguments to gain the support and commitment of
  • Manages ambiguity: Operates effectively, even when things are not certain or the way forward is not
  • Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among
  • Demonstrated ability to supervise staff in a manner that maximizes employee performance and business
  • Intermediate Word and Excel skills, including the ability to create complex formulas and
  • Ability to handle confidential information with appropriate

  • Knowledge of the regulations, guidelines and reimbursement methodologies of state sponsored

Required Experience
  • Bachelor’s Degree in Business, Public Health Administration or related discipline; and
  • At least seven years’ experience in provider/physician operations and service in a managed care health plan or similar organization and;
  • At least five years supervisory

  • Master’s Degree in Business, Public Health Administration or related discipline
  • Experience in provider/physician operations and service specific to Medi-Cal, Medicare or other government healthcare


Licenses, Registrations, Certifications

  • Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability. 

Job ID: 1323-942
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