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Director Provider Network Development Jobs in Kentucky

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Director Provider Network Development information

What are some common challenges faced by a Director of Provider Network Development, and how can they be addressed?

A Director of Provider Network Development often encounters challenges such as negotiating favorable contracts with providers, ensuring network adequacy, and balancing cost control with quality of care. Successfully addressing these issues requires strong relationship-building skills, an in-depth understanding of healthcare regulations, and the ability to analyze market trends. Collaborating closely with legal, compliance, and analytics teams can help streamline contract negotiations and maintain a competitive, high-performing network. Continual professional development and staying current with industry changes are also key for long-term success in this role.

What is the difference between Director Provider Network Development vs Provider Network Manager?

AspectDirector Provider Network DevelopmentProvider Network Manager
CredentialsBachelor's degree, industry certifications often preferredBachelor's degree, relevant certifications beneficial
Work EnvironmentStrategic planning, high-level decision making, cross-department collaborationOperational management, provider relations, network oversight
Employer & Industry UsageHealth insurance companies, managed care organizationsHealth plans, healthcare providers, insurance firms
Search & Comparison IntentStrategic development, network expansion, leadership rolesOperational management, provider relations, network maintenance

The main difference is that the Director Provider Network Development focuses on strategic growth and high-level planning of provider networks, while the Provider Network Manager handles day-to-day operations and provider relations. Both roles require industry knowledge and relevant certifications, but their scope and responsibilities differ significantly.

What are the key skills and qualifications needed to thrive as a Director of Provider Network Development, and why are they important?

To thrive as a Director of Provider Network Development, you need a deep understanding of healthcare networks, contract negotiation, and provider relations, typically supported by a bachelor’s or master’s degree in healthcare administration or a related field. Familiarity with healthcare analytics platforms, provider management systems, and knowledge of payer-provider contract regulations are crucial. Strong leadership, relationship-building, and strategic communication skills set top performers apart. These competencies are vital for building robust provider networks, ensuring compliance, and driving organizational growth in a competitive healthcare environment.

What does a Director of Provider Network Development do?

A Director of Provider Network Development is responsible for building, maintaining, and optimizing relationships with healthcare providers, such as hospitals and physician groups, on behalf of insurance companies or health plans. They negotiate contracts, ensure providers meet quality and cost standards, and help expand the provider network to meet organizational goals. This role often involves analyzing network performance, identifying gaps in coverage, and collaborating with internal teams to improve service delivery and member satisfaction.
What are popular job titles related to Director Provider Network Development jobs in Kentucky? For Director Provider Network Development jobs in Kentucky, the most frequently searched job titles are:
What cities in Kentucky are hiring for Director Provider Network Development jobs? Cities in Kentucky with the most Director Provider Network Development job openings:
Medical Director

$200 - $300/hr

Other

Life, Retirement, PTO

Posted 17 days ago


Volunteers Of America rating

6.9

Company rating: 6.9 out of 10

Based on 123 frontline employees who took The Breakroom Quiz

346th of 706 rated non-profit organizations


Job description

Medical Director
  • Posted on April 24, 2026
Locations

Showing 1 location

Louisville, KY 40243, USA

  • On-site
  • Nursing
  • Full-Time
  • Requisition #: MEDIC007829
Description

Care with Heart. Work with Purpose.

Volunteers of America National Services (VOANS) is seeking a Medical Director. The Medical Director provides direction to Senior CommUnity Care related to the medical delivery of care by providers and ensures the delivery of quality health care services. Supports and directs Senior CommUnity Care medically-related committee work. This is an onsite role. Proudly Great Place to Work® Certified for 8 consecutive years.

Location: 12710 Townepark Way Louisville, KY 40243

The Medical Director objective is to provide direction to Senior CommUnity Care related to the medical delivery of care by providers and ensures the delivery of quality health care services. Supports and directs Senior CommUnity Care medically-related committee work.

Why You'll Love It Here

  • Mission-driven work that makes a difference
  • Supportive and collaborative leadership
  • Strong, team-oriented culture
  • Opportunities for career growth and advancement
  • Inclusive and purpose-driven environment

What We Offer

  • 403(b) Retirement Plan with discretionary contribution
  • Paid Time Off (Vacation, Holiday & Sick Days)
  • Life Insurance & Short-Term Disability
  • Employee Assistance Program
  • Wellness incentives (earn up to $350)
  • Early pay access (up to 50% of earnings)
  • Referral bonuses & career scholarships

Key Responsibilities

  • Responsible for oversight of delivery of care and clinical outcomes.
  • Provides medical guidance and supervision of medical services.
  • Provides leadership and medical expertise in the development of medical policies, procedures and guidelines.
  • Responsible for the development of Senior CommUnity Care clinical standards and medical practice guidelines and protocols.
  • Provides oversight of the QI Plan.
  • Reviews all quality of care issues and oversees the development and implementation of quality of care corrective action plans.
  • Participates in the oversight, training and education of internal providers and the interdisciplinary team.
  • Coordinates performance appraisal of the Internal providers.
  • Develops educational and other programs to build the skills of participating providers.
  • In conjunction with Contract Manager engages in communication with the provider network.
  • Represents Senior CommUnity Care to external agencies, professional groups and regulatory agencies and organizations as required.
  • Demonstrates necessary skills and knowledge as outlined in position-specific competency requirements.
  • Assumes overall accountability and responsibility for the medical care of the participants at Senior CommUnity Care Program. Oversees the medical service team in the PACE program area to promote quality and outcome goals.
  • Monitors PACE medical/clinical staff to assure practice is in compliance with Occupational Safety and Health Administration (OSHA) regulations and agency policies and procedures.
  • Participates in the development and implementation of compliance programs. Enforces and promotes compliance with laws and regulations.
  • Performs initial and annual competencies on internal providers at the PACE program.
  • In conjunction with the Board, Quality Manager, is responsible for QI plan and activities. Reviews data, identifying areas of opportunity for improvement. Engages with development of annual plan and benchmarks. Participates in CMS and Senior CommUnity Care collaboration with Level 2 reporting.
  • Participates in Utilization Review inclusive of but not limited to ED visits, hospitalizations, SNF, LTC, AL, and specialty visits. Assesses for areas of opportunity for procedural, operational and/or service delivery changes.
  • Oversees CMS diagnostic coding practices at the PACE program.
  • Assists with the development of policies and procedures, standards of care. Performs on-going monitoring and evaluation of patient care practice and service delivery. Provides guidance and training to staff regarding medical and quality assurance issues.
  • Maintains participants' medical record and fulfills Senior CommUnity Care charting and reporting requirements as they apply to the Medical Director's role.
  • Protects privacy and maintains confidentiality of all company procedures, results and information about employees, participants and families.
  • Follows all Senior CommUnity Care policies and procedures and Occupational Safety and Health Administration (OSHA) safety guidelines.
  • Participates in continuing education classes and any required staff and training meetings. Maintains professional affiliations and any required certifications.
  • Schedule permitting, provides information about Senior CommUnity Care Program to interested individuals and groups in adherence to PACE regulations.
  • Serves as community liaison between Senior CommUnity Care and community physicians, hospitals, and other health care providers in the service area

Qualifications

  • Education: M.D. or DO with current state of license. DEA registration and the ability to obtain and maintain staff privileges, as needed, at Senior CommUnity Care contracted agencies. Board certified in Internal Medicine or Family Practice with advanced certification in geriatrics preferred.
  • Experience: Must have a minimum of one year of experience working with a frail or elderly population. Must have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. Minimum three (3) years of experience in a lead administrative role.
  • Must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.
  • Must have a valid driver's license, proof of insurance and have means of transportation.

At VOANS, we celebrate sharing, encouraging and embracing diversity. Equal employment opportunities are available to all without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, parental status, sexual orientation, gender identity, gender expression, genetic information, military and veteran status, and any other characteristic protected by applicable law. We believe that blending individual strengths and unique personal differences nurtures and supports our organizations shared commitment to our mission and creates an inclusive and diverse environment where everyone feels valued and has the opportunity to do their personal best.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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