Manager- Provider Excellence - Health Alliance Plan

GENERAL SUMMARY: Provide guidance and leadership to the Provider Excellence team. Reporting to Director, Provider Network Management Operations the Manager of Provider Excellence will have a dedicated team that manages the divisions projects, policies, procedures, metrics, data, and visual dashboards to help Provider Network Management division run day to day operations in a more efficient manner. Responsible for the oversight of projects that help meet Provider Network Management and HAP’s business objectives. Ensure results for projects, deliver business requirements, meet implementation timelines, and meet quality and audit standards. Establish and maintain relationships with leadership, business partners, and the provider community. Ensure Provider Network Management continually delivers high quality outcomes while maintaining compliance to the provider community. Participate and influence discussions regarding provider data short and long-term strategy.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Develop and direct the Provider Excellence team to ensure they meet the service levels, manage projects, and meet the needs and expectations of all internal and external customers.

• Manage offshore resources and/or automated resources used to meet due dates, timelines, and SLAs within the division in a compliant manner.

• Manage division budget and budgeted expenses to the organization.

• Have a solid understanding regarding the impact of technological and process changes on the division and the organization and advise on downstream implications.

• Manage requirements to ensure division submits all appropriate requests to BCT timely so due dates are met with provider community.

• Develop processes and protocols that create the framework for the Provider Excellence team to act as liaisons between Provider Network Management Division and organization gathering business requirements and overall objectives.

• Manage network lease agreements for organization.

• Maintain and establish quality standards and maintain metrics and divisional dashboards.

• Establishes and administers a divisional wide training program for internal employees and provider community.

• Oversees the design, strategy, and accuracy of provider data reports that are externally deployed.

• Oversee the development and implementation of change enablement strategies, processes, and methodologies, including change management. Identify the need for change, anticipating, recognizing, reimagining work while creatively addressing resistance to change; working with others to view change as an opportunity for growth.

• Develop staff and encourage new ideas/approaches.

• Use efficient and cost-effective approaches to integrate technology, process and procedures into the workplace and improve program effectiveness.

• Collaborate with business partners to maintain and develop training materials.

• Perform other duties as assigned.