The main and basic responsibility of a Director of Provider Relations is to work with affiliated companies and ensure that all negotiations are settled at the best deal for the organization. The job description and duties are listed on the Director of Provider Relations Resume as – managing long-term contracts with various providers, ensuring the supplies and other contracts are carried out as per the agreed terms and conditions, solving provider issues, and contract agreements, and ensuring quality relationships between clients and the company. The job description includes monitoring the group of workers as they build a relationship with providers.
Skills that are normally considered vital for this role include – strong communication skills, the ability to negotiate terms and conditions with providers, strong management skills, technical capabilities, conflict resolution skills, and strong management skills. The ideal candidate for this role must possess at least a degree in business or a related.
Summary : Over 15 years of upper leadership experience in all areas of home care, MLTCP, residential treatment, quality improvement, utilization review, and substance abuse services.
Skills : Leader, Disciplined, Team Player, Proactive, Positive.
Description :
Strategically directed the development of a Heath Care System with, emphasis on business, health and policy, I made a significant contribution to improving the health of the communities they serve.
Provided oversight to 28 facilities in WV.
Coordinated with communication of Genesis polices, services, census goals and systems throughout each practice location.
Started they had one physician that was contracted with our team, within a year was able to recruit 5 contracted doctors and had Medical Director Contracts at every facility in WV.
Responsible for expanding and refining the Genesis Health Care network consistent with the mission and goals of Genesis Physicians Services.
Responsible for analyzing network needs identifying strategic opportunities and tracking and reporting all development activity.
Directed, advocated and contacted during the on -boarding process and maintain ongoing relationships with contracted and non contracted providers.
Experience
10+ Years
Level
Senior
Education
Masters Of Arts
Director of Provider Relations Resume
Headline : To obtain a challenging Director of Provider Relations position which offers the opportunity to use my experience in business development, customer service management and expertise in census driven sales.
Skills : MS office, Developing Skills.
Description :
Maintained a constant source of information relating to new physician contacts and appropriately recruited these practitioners to Genesis Physician Services.
Coordinated the communication of GPS policies, services, census goals and systems throughout all practice locations, with clinical services and other ancillary services within the centers.
Worked closely with Genesis external care coordinators, regional vice presidents and clinical services to ensure maximum effectiveness of all GPS providers.
Responsible for meeting the regional clinical and operational goals and objectives.
Developed and maintained information about current physician practice opportunities at Genesis Health Care owned and operated nursing centers.
Established procedures to assure effective efforts in physician development activities.
Assisted Provider Relations in implementing development strategies for residents, practicing physicians including sourcing, telemarketing, mass mailing, and advertising and job fairs.
Experience
5-7 Years
Level
Executive
Education
Master Of Science
Director of Provider Relations Resume
Objective : Looking to leverage performance analysis expertise and in-depth knowledge of human relations, project management, and staff recruitment, retention and training pursuing an Administrative level position. Organized self-motivator who's earned promotions through a proven record of achievement. These promotions were attributed to being a strategic problem-solver, strong communication skills with ability to work across all levels of an organization.
Skills : Excel, Leadership, Fluent In Medical Terminology, Technology, Team Development, Event Planning.
Description :
Managed ten FTE's that include six Registered Nurses and one Respiratory Therapist.
Actived Member of the Senior Management Team.
Developed and implemented departmental strategic plan.
Increased patient days by 20% over previous year.
Increased commercial patient days by 54% over previous year and 70%.
Successfully organized four Open Houses highlighting hospitals' flagship Wound Care Program and Radiology Department, as well as the Grand Opening for the Intensive Care Unit.
Oversaw all hospital admissions and census.
Experience
2-5 Years
Level
Junior
Education
MS
Director of Provider Relations Resume
Objective : Highly qualified Director of Provider Relations with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and I would excel in the collaborative environment on which your company prides itself.
Coordinated and assists in development, maintenance and acquisition of necessary recruitment collateral's and determines distribution of such materials to prospective candidates.
Participated in external recruitment and recruitment education efforts including but not limited to, medical association conferences and national/regional recruitment seminars.
Maintained administrator on call responsibilities, as assigned, to act as problem solver for clinical unit on a 24-hour basis.
Responsible for developing and implement a successful marketing strategy that would enhance census in a multi-facility setting.
Required strong relationship building and community involvement to include partnering with Hospital Discharge Planners, Social Workers, Physicians, Home Health Agencies, Assisted Living Facilities, and Health Care Providers.
Kept Occupancy rate at 98% along with maintaining quality mix in multi-facilities.
Assisted the Administrators with any of their duties as needed.
Experience
2-5 Years
Level
Junior
Education
GED
Director of Provider Relations Resume
Objective : To obtain employment within an established company where I can apply my management and customer service experience on a daily basis.
Skills : Microsoft Office, Quickbooks, Peoplesoft.
Description :
Planned, directed, monitored, coordinated, organized and evaluated administrative operations, including: marketing, recruiting and maintaining relationships with physician base at Select Specialty Hospital - Kansas City, Inc.
Directed marketing efforts through communication with physicians, case managers, managed care companies, hospitals and administrators in the Kansas City Metropolitan area, resulting in the maximum allowable bonuses for exceeding census and budget.
Collaborated with Administrative Staff to create short- and long-term strategic initiatives for SSH locations in the Kansas City Metropolitan Area.
Developed and implemented policies, procedures, services and programs to maintain quarterly marketing team action plans as part of the SSH strategic plan.
Actively negotiated and retained Managed Care contracts with multiple payor sources.
Performed individual negotiations as warranted.
Managed human resources by interviewing, rating, ranking and selecting qualified applicants for marketing and admission departmental positions.
Experience
2-5 Years
Level
Junior
Education
M.B.A.
Director of Provider Relations Resume
Headline : To join an organization that has a strong commitment to customer service and employee satisfaction. Contributions to this organization will be to excite, guide, and empower individuals to achieve personal, career, and strategic goals.
Skills : Microsoft Office, Operational Skills.
Description :
Conducted provider network analysis and contracted with physicians, hospitals and ancillary providers to fill gaps in network.
Revised contract language to meet state regulations and NCQA requirements.
Prepared Member Handbooks, Provider Manuals, and Provider Directories.
Worked closely with Health Services to identify areas for additional education.
Oversaw daily operations of Provider Relations Department.
Assisted multi-facility million dollar renovations along with all of the marketing events that go along with Grand Openings.
Increased the dental HMO provider network by an average of 34% annually.
Experience
5-7 Years
Level
Executive
Education
Certificate In Paralegal
Director of Provider Relations Resume
Summary : Strategic and tactically focused Director of Provider Relations with 20 years of experience directing a wide array of business activities. Highly skilled at leading local, telecommuting, satellite, and international teams in operational excellence, cost containment, contract negotiating, supplier management, and revenue generation.
Skills : Basic Computer, PowerPoint.
Description :
Directed the strategic development of the Physician Recruiters and Coordinators.
Designed and implemented quality assurance programs and hospital-based ancillary programs.
Assistanted Director of Provider Relations Assumed managerial responsibilities in the absence of a Director.
Trained Physician Coordinators and administrators on new marketing directives Physician Recruiter/Coordinator Served as a communication liaison to contracted physicians and senior management.
Updated providers of new and/or revised policies.
Presented US Healthcare plans to selected physicians, hospitals and medical associations.
Established regional networks.
Experience
10+ Years
Level
Senior
Education
Baccalaureate Of Science
Director of Provider Relations Resume
Summary : To pursue and obtain a Director of Provider Relations position where I am able to contribute my knowledge and experience toward the ongoing success and growth of your business and the individuals it serves.
Skills : Managing Skills, Supervising Skills.
Description :
Created to secure the start-up of a competing long term acute care hospital in Augusta.
Opened Hospital-in-Hospital knowing the area's competition - Select Hospital.
Budgeted census exceeded every month for the first ten months.
Developed referral base, recruited physicians and secured buy-in from the largest hospital in the area.
Built successful admissions and sales department after insuring Medicare certification.
Negotiated insurance rates until contracts could be established.
Supervised the work of the staff of 10 LCPC's and LCSW's assigned to the Provider Relations Department.
Experience
10+ Years
Level
Senior
Education
MS
Director of Provider Relations Resume
Headline : Responsible as the lead contact and manager of learning materials, web-based learning center, assessment & measurement, maintenance, and re-design process for programs. Identifies and clarifies training needs. Provides recommendations for learning solutions and evaluation strategies, while partnering in the design of program materials, and facilitating live and virtual learning programs.
Skills : Implementational SKills, Analyst.
Description :
Responsible for education, performance reporting, provider updates and network development of both internal and external customers.
Served as a resource for routine information and as coordinator/liaison for researching provider questions and communicating findings to providers.
Developed professional, effective relationships within hospitals, physician offices, and ancillary providers, as well as with contracted health plans, utilization management, and member services departments, continually updating providers of operating policies and procedures for Health Plans through written materials and media.
Composed, negotiated, implemented and maintained ISO vendor contracts.
Generated $3.5 million in new business in two years.
Developed and coordinated a 300-person volunteer program for the care of hospice patients.
Recruited, hired, supervised and trained employees under direct supervision.
Experience
5-7 Years
Level
Executive
Education
Bachelor's In Applied Sociology
Director of Provider Relations Resume
Summary : Over twenty years of experience in the healthcare field and able to work independently, under minimal supervision with the ability to assess, refer, and/or resolve complex inquiries and issues for the corporate office. Excellent organizational skills in working with a high volume of multiple tasks and the ability to promote and support a team environment by having extensive contact with officers, associates, and clients requiring excellent people skills and knowledge.
Skills : COmmunication SKills, Finance.
Description :
Recruited and maintained relationships with community mental health providers for the Medicaid multi-county East Metro service area membership of 260,000 covered lives.
Primarily responsible for securing contracts and facilitating the credentialing and recredentialing process for individuals, multi-specialty groups, residential facilities, community mental health centers and hospitals.
Responsible for responding to inquiries from providers, identifying potential problems, resolving complex claims issues, researching inquiries, and working closely with the appropriate people and departments, whether external or internal, to assure appropriate resolution.
Developed necessary training materials for providers including electronic presentations, provider manuals and provider directories.
Provided training on policies and procedures related to utilization management functions including authorizations and claims submission for all participating providers as well as organization involved with the agency.
Reported quarterly to Health Care Policy and Finance on the provider network composition, needs and any potential barriers.
Responsible for the leadership, strategy, development and on-going management and maintenance of the provider panel including all aspects of contract negotiation and provider payment.
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