Job Description:

This position manages Provider Development functions in support of the development, contracting, and management of contracted SelectHealth providers, vendors, and facilities. Manages Provider Development processes, including: Credentialing, contracting, compliance, programs, projects, initiatives, services, administration, and other key activities associated with supporting providers and networks. Manages key Provider Development functions, including caregivers, to ensure superior service is provided to all internal and external customers compliance, operational excellence, and superior service.

Scope

Reports to the SelectHealth Director of Provider Development. Has 2 or more direct reports and may have more than 15 indirect reports. This position is accountable for the management of Provider Development functions in support of the development, contracting, and management of provider, vendor, and facility networks in all markets.

Job Essentials

Leadership

• Demonstrates core leadership competencies including: Building a successful team, building strategic work relationships, coaching, communication, customer focus, facilitating change, financial acumen, planning and organizing, and selecting talent.
  • Prioritizes opportunities to develop employees at all levels thereby sustaining SelectHealth culture which encourages transparency, collaboration, and an atmosphere where all employees feel respected and valued.
  • Manages team operations, including ongoing implementation of the Intermountain Operating Model, Continuous Improvement, key performance indicators, caregiver engagement, and department alignment.
  • Recruits, develops, and motivates staff to ensure a highly engaged and values focused team.
  • Serves as the liaison between Provider Development, SelectHealth, Intermountain, and other entities on alignment and integration issues such as compliance, configuration, and directory accuracy.

Credentialing and Contracting Administration

• Manages credentialing and contracting administration functions in all markets for all provider types, including delegated arrangements with CAQH and other entities.
• Coordinates contracting configuration activities with SelectHealth Legal, Operations, Service Excellence, credentialing, and other relevant departments to ensure contracts are accurate, implemented, and organized in the system.
• Ensures department credentialing and contracting administration functions are in alignment with NCQA, CMS, and other state specific requirements.
• In collaboration with Operations, ensures system credentialing and contract configuration is in alignment with system best practices.
• Manages all provider data files for provider networks to ensure systems and provider directories accurately reflect each commercial and government network on an ongoing basis.

Department Compliance

• Maintains a working knowledge of all CMS, NCQA, state, and other requirements.
• Oversees department process, policy, and procedure to ensure ongoing compliance with federal, state, organization policy, and other regulatory agencies.
• Maintains comprehensive documentation of all compliance and accreditation requirements, including sources, ensuring ongoing audit readiness.
• Represents Provider Development in interactions with internal and external audit and compliance.
• Ensure comprehensive and accurate reporting of policies, procedures, and guidelines to internal and external auditing agencies.
• Manages process for network adequacy reporting to federal and state agencies.
• Maintains alignment with Quality Improvement, Internal Audit, Compliance, Legal, Operations, and other key SelectHealth departments.
• Oversees and performs delegated credentialing and contracting audits, including ongoing reporting and monitoring.

Project Management and Coordination

• Oversees and manages Provider Development projects and initiatives in all markets.
• Maintains alignment with the SelectHealth Project Management Office, Operations, Sales, Product, Marketing, Government Programs, Actuarial, Reporting, Network Affordability, and other internal teams.
• Tracking and reporting of all key department projects.
• Facilitates data analysis and internal/external data modeling.
• Produces department data analysis, including facilitating data requests.

Minimum Qualifications

• Five years of demonstrated progressive leadership experience in health insurance, operations, financial services, healthcare administration, or other related industry.
• Demonstrated intermediate proficiency in word processing and spreadsheet programs.
• Demonstrated excellent written, verbal and interpersonal communication skills.
• Demonstrated excellent project, time and workload management skills.
• Demonstrated experience in process improvement.

Preferred Qualifications

• Bachelor's degree in Business Administration, Communication or Healthcare or related field. Degree must be obtained through an accredited institution. Education is verified.
• Master's degree. Degree must be obtained through an accredited institution. Education is verified.
• Experience working in health care or health insurance business environment.
• Demonstrated experience in relationship building
• Demonstrated analytical and technical abilities.

Physical Requirements:

SH only

Interact with others requiring the employee to communicate information.
- and -
Operate computers and other office equipment requiring the ability to move fingers and hands.
- and -
See and read computer monitors and documents.
- and -
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Anticipated job posting close date:

08/31/2023

Location:

Denver Midtown

Work City:

Denver

Work State:

Colorado

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$43.24 - $66.74

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.