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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 the most commonly searched types of Provider Network Development jobs in Texas? The most popular types of Provider Network Development jobs in Texas are:
What are popular job titles related to Director Provider Network Development jobs in Texas? For Director Provider Network Development jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Director Provider Network Development jobs in Texas look for? The top searched job categories for Director Provider Network Development jobs in Texas are:
What cities in Texas are hiring for Director Provider Network Development jobs? Cities in Texas with the most Director Provider Network Development job openings:
Director Provider Network Development jobs near you
Provider Relations Advocate

Provider Relations Advocate

UnitedHealth Group

Corpus Christi, TX • On-site

Full-time

Retirement

Posted 22 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

188th of 890 rated healthcare providers

Job description

Explore opportunities with WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind Caring. Connecting. Growing together.
The Physician Business Manager with WellMed is responsible for developing, maintaining, and servicing a high quality, marketable, and satisfied provider network within an assigned geographic area. The Physician Business Manager helps assigned providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals. This position is expected to build and sustain solid working relationships with cross functional departments, vendors, local network, and assigned providers. The Physician Business Manager is accountable for overall performance and profitability for their assigned groups, as well as ownership and oversight to provide redirection as appropriate.
Primary Responsibilities:
  • Educate providers to ensure that they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans
  • Ensure providers have in-depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives, and patient care best practices
  • Conduct detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
  • Ensure the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others, as needed
  • Participate in creation and execution of a local network development plan to assure network adequacy as needed
  • Conduct new provider orientations and ongoing education to providers and their staff on healthcare delivery products, health plan partnerships, processes, and compensation arrangements
  • Maintain open communication with providers to include solutions for resolution and closure on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment programs
  • Conduct provider meetings to share and discuss economic data, troubleshoot for issue resolution, and implement an escalation process for discrepancies
  • Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
  • Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs
  • Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
  • Collaborate with contracting team to ensure provider data is correct and provider directories include any needed updates
  • Complete Practitioner Data Forms and Provider Change Forms as needed
  • Represent WellMed/UHG by holding company sponsored provider events (summits, learning sessions)
  • Provide information and participate in management meetings as requested
  • Regularly meet with cross functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goals
  • Provide support to maintain and develop ongoing value related to the WellMed Value Proposition
  • Introduce and advocate company resources to facilitate practice optimization
  • Ability to travel as needed 50 - 75% within market

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • High School Diploma/GED or equivalent experience
  • 2+ years of provider relations or managed care experience
  • Intermediate level of proficiency with MS Suite (including Word, PowerPoint, and Excel)
  • Ability to work evenings and weekends on occasion based on business needs
  • Ability to travel as needed 50 - 75%
  • Access to reliable transportation and valid US driver's license

Preferred Qualifications:
  • Bachelor's degree in related field
  • LVN license
  • Experience presenting group presentations and training
  • Professional provider relations experience involving physicians and administrative staff
  • Significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
  • Understanding medical care financing and delivery systems, provider contracting, reimbursement arrangements, and network management
  • Established knowledge of local provider community
  • Proven excellent analytical and problem-solving skills with effective follow-through

Physical & Mental Requirements:
  • Ability to lift up to 25 pounds
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will rangefrom $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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