Director, Provider Services and Credentialing

ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

Position Summary

The Director of Provider Services and Credentialing (Director) is responsible for developing, maintaining and enhancing relationships with network partners, integrating strategic planning and tactical execution of strategies that ensure high quality, cost-effective of care, while supporting company goals and objectives. The Director plays a key role in the design and execution of provider contracting activities and provider management for ILS. The Director leads the credentialing team to ensure the timely and accurate credentialing of providers as per company, regulatory, accreditation, and client requirements.

Essential Functions 

1. Conducts interviews and hiring of direct reports. Completes a ninety-day introductory and annual performance evaluation of each direct report. Facilitates professional growth and improved proficiency of staff who are direct and indirect reports through mentoring and training. Conducts ongoing performance management of each direct report; establishes performance goals; and measures performance against goals.
2. Contributes to the development and implementation of strategic and technical plans to ensure improved adequacy and performance of network providers including, but not limited to, annual network development plans and provider satisfaction action plans for ILS managed care initiatives and other ILS clients. Assists in preparation and review of reports, applications and associated documents for filling with state agencies and CMS as required. 
3. Directs the development of innovative provider contract arrangements and provider relationships designed to further ILS’ strategic objectives. Directs the identification of potential provider targets for ILS managed care initiatives and other ILS clients. Directs provider recruiting and contracting activities for new providers. Negotiates, and processes provider agreements (SCAs, LOAs, and full contracts) for ILS managed care initiatives and other ILS clients, ensuring contracts is compliance with contractual and regulatory requirements.
4. Directs the development and maintenance of relationships with contracted providers by providing guidance and assistance throughout the year. Monitors operational and financial performance of contracts to guide future recruitment activities and future contract negotiations. Develops and implements solutions to identify and address process and quality gaps, including periodic review of existing contracted providers as required. Collaborates, educates, and engages PR staff on low performing contracted providers to develop improvement and corrective action plans as needed.
5. Directs oversight and assurance of necessary reporting and monitoring of the credentialing cycle and support staff to ensure timely approval of credentialing files by established Credentialing Committee(s). Directs the management of delegated credentialing groups and vendors (i.e., physician groups and subcontractors).
6. Provider oversight of the Provider Relations responsibilities delegated by Vivida Health to ILS, including, but not limited to, provider credentialing, and contracting. Prepare and oversee weekly Vivida-ILS Provider Relations conference calls. Assisted in review and preparation of documents/spreadsheets, credentialing and provider contracting associated with acquisition and sale of HPNY.
7. Directs problem resolution for complex problems between providers, claims and member relations groups. Directs Provider Network staff in problem resolution as necessary. Works with other departmental areas (provider data management, credentialing, utilization management, case management, claims, IT) to facilitate problematic issues and bring them to resolution. Develops and implements action plans as needed to remediate areas of concern.
8. Analyzes and recommends adjustments in organization, staffing, systems, and operational procedures. Prepares and maintains (and updates as needed) department policies and procedures. Prepares presentations, gathers, and consolidates materials to participate in plan audits and accreditations.
9. Attend industry events and annual conferences to further foster relationships with network providers.
10. Performs other duties as required or assigned.  

Education and Experience

• Bachelor’s degree (Master’s degree preferred) with 10 years of experience in provider network operations, provider relations or healthcare administration and/or training
• Two (2) years in a supervisory with administrative capacity; or an equivalent combination of training, education and experience which demonstrates the ability to perform the duties of the position.
• Experience in government programs (Medicare, Medicaid, MLTSS, FIDA, etc.) is desired.

Required Skills

• Proficient with Microsoft Office suite

• Strong verbal and written communication skills, including ability to conduct effective presentations. 
• Critical thinking, sound decision-making and solid leadership ability

EEO STATEMENT 

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.