Director, Provider Partnerships

Blue Cross and Blue Shield of Kansas City; Kansas City (MO); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Total rewards package

Annual incentive bonus

Paid holidays

PTO

Volunteer time off

Tuition reimbursement

Parental leave

Adoption assistance

Employee discount

Job summary

Blue Cross and Blue Shield of Kansas City is seeking a Senior Manager of Provider Engagement to define strategy and manage relationships with physician groups, hospitals, and ancillary providers.

The role collaborates across the organization to set priorities, influence care delivery strategies, and oversee provider payment solutions and the provider account executive team. Strong leadership and healthcare industry knowledge are essential.

Qualifications

• Bachelor’s degree in business administration, health care administration or related field.
• 5 years of Provider Team, Healthcare or Managed Care experience.
• 5 years of management experience.
• Extensive knowledge of Managed Care processes, claims adjudication and provider experience.
• Advanced knowledge of Microsoft Windows and Office applications (Word, Excel, Access, PowerPoint).

Responsibilities

• Define strategy and manage relationships between provider entities including physician groups, hospitals and ancillary providers.
• Meet with providers to align on strategic concepts, planning data and performance metrics.
• Oversee provider payment solutions and provider account executive activities.
• Support population health management and value-based contracting initiatives.
• Lead the provider issue resolution team and ensure timely, positive outcomes.
• Collaborate with internal and external partners to improve staff/provider engagement.

Skills

Provider engagement

Healthcare management

Leadership

Strategic partnerships

Project coordination

Education

Bachelor’s degree in business administration or health care administration

Tools

Microsoft Windows

Microsoft Word

Excel

PowerPoint

Access

Job description

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

Job Description Summary

This position is a key partner in developing and implementing programs for provider engagement, communication, and other strategic initiatives. This position works closely and collaborates with other leaders throughout the organization to determine strategic priorities for Blue KC to influence care delivery strategies, quality programs and network engagement. This position is key in establishing productive relationships with the provider community.

Job Description

Defines strategy and directly manages relationships between key provider entities including physician groups, hospitals, and ancillary providers. Meets independently with providers to engage at a detailed level representing the company’s best interest. Supports the implementation of healthcare redesign, provider reimbursement and partnership strategies, and manages healthcare costs while improving outcomes and the healthcare experience for our members. Day to day oversight of provider payment solutions and provider account executive (PAE) activities. Works collaboratively with other areas to assist with provider engagement activities supporting population health management and value-based contracting. Presents information such as strategic concepts, planning data, medical expense/reimbursement rates, provider performance metrics and impact assessments to both internal and external audiences at all levels, including senior leadership. Accountable for the design, implementation, and operations of Blue KC’s provider issue resolution team. Responsible for the daily oversight of the service model impacting provider satisfaction, collaborates with internal and external business partners to ensure staff performance on aligned operations functions and communicates with Blue KC’s leadership on staff’s provider engagement and performance. Engages with PAE’s on issue resolution to ensure issues are handled timely with a positive outcome. Supports PAE’s with resources to elevate provider issues that require business partners engagement for resolution Oversees and manages staff educational needs affecting staff and providers

Minimum Qualifications

• Bachelor’s degree in business administration, health care administration or other relevant academic discipline
• 5 years of Provider Team, Healthcare or Managed Care Experience, may be combined experience
• 5 years of management experience
• Extensive knowledge of Managed Care Processes, Claims Adjudication, Provider Experience
• Advanced level knowledge of and ability to use Microsoft Windows and Office applications such as Word, Excel, Access, and PowerPoint

Preferred Qualifications

• 7 years of Provider Team, Healthcare or Managed Care Experience, may be combined experience
• 7 or more years of management experience

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

At Blue Cross and Blue Shield of Kansas City (Blue KC), we have long put our members first by developing products and services to meet our needs. From our founding in 1938 to more than 80 years of experience in innovative, patient-centered healthcare coverage, Blue KC continues to keep our members at the center of everything we do. As a market leader, we continue to embrace new ideas to make healthcare more affordable and to improve the customer experience.

Blue Cross and Blue Shield of Kansas City will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems.