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Director, Provider Partnerships

2 months ago

Madison, Wisconsin, United States Quartz Health Solutions Full time
About the Role

We are seeking a highly experienced and results-driven leader to join our team as Senior Director, Provider Network Development. This role will be responsible for developing and executing strategies to build and maintain strong relationships with healthcare delivery systems across our markets in Wisconsin, Illinois, Iowa, and Minnesota.

Key Responsibilities
  • Strategic Planning and Partnerships
    • Develop and implement a comprehensive strategy to build and maintain strong relationships with key healthcare delivery systems.
    • Collaborate with internal stakeholders to identify business opportunities and develop mutually beneficial partnerships.
    • Translate business vision and strategy into clear operational goals, objectives, and tactics.
  • Provider Network Management
    • Educate and train providers on changes to our risk adjustment strategies and provide support to practices lacking necessary tools and resources.
    • Work with applicable teams to complete required filings and proactively address errors.
    • Oversight of all outbound provider communication, including newsletters and notification of program changes.
  • Contracting and Risk Adjustment
    • Develop and implement contract workflows to optimize performance, decrease errors, and meet state and federal regulations.
    • Oversee the development, implementation, and coordination of all aspects of provider contracting.
    • Drive Value-Based solutions that optimize financial performance, quality, risk adjustment, and clinical programs.
  • Operations and Leadership
    • Add, consolidate, or eliminate vendors as necessary to continually optimize the collective performance, efficiency, and cost-effectiveness of our risk adjustment, credentialing, and network adequacy solutions.
    • Support and inform data analytics activities, value-based care administration, and clinical program oversight and deployment in provider network.
    • Advocate for and align the scope and capabilities for the Provider Affairs Department to optimize performance, meet evolving market and regulatory requirements, and address the needs of owner systems and network providers.
Requirements
  • Bachelor's degree in business, healthcare administration, or related field.
  • 15+ years of experience in the healthcare industry.
  • 5+ years of recent senior leadership experience.
  • 5+ years of experience in a client-facing contract negotiations role.
  • 5+ years of experience in provider contracting and network management.
  • Strong understanding of healthcare and/or health plan operations and market economics.
  • Knowledge of operations and regulatory requirements for risk adjustable health plan products and quality measures related to value-based provider contracting.
  • Knowledge of medical coding and diagnostic coding, and risk adjustment methodologies.
  • In-depth knowledge of the healthcare provider landscape across Wisconsin and Quartz networks.
  • Proficient with Microsoft Office applications.
  • Well-developed communication skills with a high degree of diplomacy and persuasiveness.
  • Proven ability to build and lead a high-performing team.
  • Ability to quickly understand and evaluate complex financial structures and operational workflows.

Quartz Health Solutions offers an excellent benefit and compensation package, opportunity for career advancement, and a professional culture built upon the foundations of Respect, Responsibility, Relationships, and Resourcefulness.

Quartz Health Solutions values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer.