Job Details: Director of Physician Relations

Company: Presbyterian Hospital – We have locations throughout the state in both rural and urban locations. We're bound to have opportunities for you.

Description: Requires in depth knowledge of physician group administration, operations, structure and contract arrangements and financial management of capitation in terms of what and how work is to be done as well as why it is done.

Minimum Skills/Requirements:
Bachelor's degree in business administration, Healthcare Administration, or related health care field. Five or more years experience in a health plan and/or organized provider network setting. Demonstrated management, analytical, negotiating, facilitation, and organizational, and staff development skills required. Able to work independently, self manage work time and projects, resolve highly complex issues with minimal assistance. Proved superior oral, written, presentation, and interpersonal communication skills required. Must also possess strong personal computing skills. Hands on experience with computer systems that support health plans and/or physician networks.
Detailed understanding of interfaces and interdependencies between functional areas in the health plan and physicians groups in the areas of eligibility, encounter data, capitation payments, utilization management, quality management, member services, appeals, claims administration, finance, information systems, and contracting. Knowledge of general customer service and education principles as related to physician practices.

Primary Job Functions:
• Acts as the liaison and resource to senior management of physician networks and primary contact to address issues of high complexity. Communicates effectively with all levels of physician office staff and management.
• Independently resolves issues with high complexity, including issues not resolved by Regional Managers. Brings issues to a higher level when appropriate with complete documentation, research and suggested solutions. Communicates realistic resolution time frames to physician practices as needed.
• Reviews and evaluates data from PMG regarding performance measures and success measures. Utilizes data to identify trends or issues to be addressed with PMG.
• Responsible for management, including agenda and materials, of PMG JSC Team, chairs meetings to ensure effective outcomes. Ensures written documentation of Team meetings and follow up items. Responsible for participation and commitment of team members.
• Directly supervises Regional Provider Services Managers, CARE Unit Manager, Operations Manager and Training Specialist.
• Responsible for development and implementation of physician and practice manager educational outreach programs and, where needed, Corrective Action Plans in coordination with appropriate functional experts with specific tasks and due dates for completion. Responsible for monitoring CAPs, ensuring compliance with CAPs and taking appropriate action when practices are non-compliant.
• Leads multi-functional task forces with representatives from the Health Plan and the provider's business office, when necessary, to resolve complex issues.
• Leads development of training programs to the provider business offices and Health Plan employees and/or departments.
• Ensures network compliance with all regulatory requirements for new network development including HCFA, NCQA, and DI, and acts as a resource to the physicians and other providers for questions or guidance on compliance concerns.
• Develops and manages team budget.
• Develops potential networks to support the PHP business objectives
• Oversee any ad-hoc audits as determined by routine reporting and monitoring
• Develop network policies and procedures
• Assures Provider Relations staff participation in contracting activities where required, including appropriate participation in all SME (Subject Matter Expert) team meetings for new and/or amended contracts
• Assumes responsibility for monitoring physician satisfaction through solicitation of feedback regarding provider services coordinators, representatives, and regional managers.
• Identifies appropriate interventions to increase provider satisfaction through analysis of the results of the annual physician satisfaction survey and implements interventions, also monitors effectiveness of interventions.
• Assures compliance to all departmental and PHP policies and procedures, particularly to those surrounding follow-up and check-in with physicians on the accuracy of new or changed contract configurations
• Performs other functions as required.

Posting Date: Jul 8 08