Provider Network Director jobs in Louisville, KY

Provider Network Director directs and develops a healthcare provider network. Designs and administers policies and services that comply with all contractual and regulatory requirements. Being a Provider Network Director requires a bachelor's degree. Typically reports to top management. The Provider Network Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Provider Network Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

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Provider Network Director - Remote in KY
  • UnitedHealthcare
  • Louisville, KY FULL_TIME
  • At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

    The Provider Network Director is responsible for the full range of provider engagement and adequacy strategies. The Provider Network Director will design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. This role will oversee and seek to improve and simplify end-to-end provider experience including service interactions, appeals and complaints, and general relationship status. Responsibilities also include directing and implementing strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims. The Provider Network Director will spend time connecting with providers directly, both virtually and in person, and assimilating and analyzing data to gain better visibility into provider experience.

    This position must operate within Kentucky.


    If you are located within the state of Kentucky, you will have the flexibility to work remotely* as you take on some tough challenges.

    Primary Responsibilities:
    • Manage provider complaints to resolution when initiated through regulators including, but not limited to DMS, DOI, or Legislators. Report status updates to DMS and providers, as needed. Implement solutions that educate network on how to resolve issues with UHC resources
    • Proactively partner with providers to identify opportunities for improvement, opportunities for growth and collaboration, and to gain general feedback regarding provider experience
    • Partner with Director of Operations to investigate and solve operational challenges. Report status updates to DMS and providers, as needed. Maintain consultative and collaborative approach with providers through resolution
    • Engage in onsite visits with providers. Utilize data analysis to determine the best strategy to choose which providers should be visited. Factors may include complaints, claim volume, attribution, quality measures, overlap with other teams, etc.
    • Manage regulatory reports for the KY network. Partner with technical and functional teams to compile and audit reports
    • Manage Appeals & Grievance Analyst, which includes coaching, mentorship, collaboration, auditing and monitoring, establishing development and career planning, and more
    • At least monthly, facilitate meetings with all provider-facing teams including, but not limited to provider relations, network contracting, growth, quality, and subcontractor provider teams
    • Attend key provider conferences including DMS Provider Forums, KPCA Provider Conferences, KHA Provider Conferences, etc.
    • Show leadership with subcontractors who manage provider networks, including dental and vision
    • Lead and facilitate meetings with providers and provider groups including KHA and other provider meetings where regulators are present. Attend and contribute to other virtual provider meetings including KPCA collaboration meetings
    • Attend assigned TAC meetings and contribute to the conversation showing leadership and subject matter expertise about our provider experience
    • Partner with other provider teams to build expertise and relationships including credentialing, contracting, provider education, PDAD, etc.
    • Partner with providers In the adoption of enterprise tools that reduce administration, including but not limited to POCA (Point of Care Authorizations)
    • Monitor Provider NPS with a focus on improvement
    • Oversee provider communications, including the following:
      • Manage annual update and publication of provider manual
      • Participate in quarterly provider newsletter production
      • Conduct provider website review monthly and partner with web teams for updates as needed
    • Attend Call Calibration sessions to better understand provider experience and provide coaching and guidance to customer service team to improve the experience
    • Be a subject matter expert regarding contract obligations relating to network
    • Meet with DMS and other regulatory points of contact, as needed. Focus on relationship building, maintaining awareness and transparency, and making progress
    • Consistently monitor network adequacy through Geo-Access reports and partner with UHN and other network teams to fill network gaps
    • Partner with Enrollee Services Director to solicit member feedback around provider experience and network gaps
    • Drive Health Equity initiatives and SDoH goals within the network of providers
    • Partner with UHC and other functional areas on Value Based Contracting opportunities
    • Represent UHC in in-person provider meetings, DMS Provider Forums, and other Provider Related conferences, which will require the ability to travel within KY at least 25% of the time

    You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
    Required Qualifications:
    • 5 years of Provider Network Experience
    • 3 years of Government Insurance Program Experience* Medicaid, DSNP, Medicare, etc.
    • 3 years of experience managing multiple projects
    • 3 years of experience with direct communication with Regulators
    • Demonstrated ability to establish and achieve a Provider network adequacy and engagement strategy
    • Intermediate level of proficiency with MS Word, Excel, and PowerPoint
    • Understanding of Medicaid contracting process, including downstream agreements
    • Proven ability to establish and monitor key performance indicators
    • Proven ability to meet deadlines
    • Proven ability to influence course of action when other teams are directly accountable for outcomes

    Preferred Qualifications:

    • Experience with Compliance Audits
    • Advanced reporting techniques (SQL, PowerBI, etc.)
    • Proven excellent organizational skills

    • All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

    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.

    Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

    UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
  • 9 Days Ago

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Provider Network Development Manager
  • eBlu Solutions LLC
  • LOUISVILLE, KY FULL_TIME
  • DescriptionPOSITION DISCRIPTION: As a Provider Network Development Manager, this role is responsible for expanding our network of provider practices and infusion management groups by selling our eBlu ...
  • 11 Days Ago

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Clinical Engineering Network Director - Louisville, KY
  • TRIMEDX
  • Louisville, KY FULL_TIME
  • If you are wondering what makes TRIMEDX different, it's that all of our associates share in a common purpose of serving clients, patients, communities, and each other with equal measures of care and p...
  • 15 Days Ago

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Network Specialist
  • Western Kentucky University
  • Bowling Green, KY FULL_TIME
  • Location: Bowling Green, KY Category: Staff Posted On: Fri Dec 16 2022 Job Description: Purpose of Position As a member of the Network Services team, the Network Specialist position configures, implem...
  • 15 Days Ago

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Network Administrator
  • Southeast Christian Church
  • Louisville, KY FULL_TIME
  • Our Mission is to connect people to Jesus and one another and our Network Administrator will facilitate that by managing and maintaining Southeast Christian Church’s network and wireless infrastructur...
  • 3 Days Ago

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Network Engineer
  • Churchill Downs Incorporated - Louisville, KY
  • Louisville, KY FULL_TIME
  • SUMMARY:The Network Engineer is responsible for design, implementation, maintenance, troubleshooting, monitoring, and reporting of the enterprise network infrastructure of Churchill Downs Incorporated...
  • 4 Days Ago

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0 Provider Network Director jobs found in Louisville, KY area

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Sales Manager
  • Common Bond Hotels
  • Louisville, KY
  • The Common Bond Hotel Collection is looking for a Sales Manager to support their current properties in Bardstown and Lou...
  • 4/19/2024 12:00:00 AM

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RN Access Specialist - Access Point (Remote)
  • RehabCare
  • Louisville, KY
  • Access Point has an opening for a Access Specialist III to join the team! Lifepoint Health is a leader in community-base...
  • 4/19/2024 12:00:00 AM

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HR Director Supply Chain
  • MHS Global
  • Louisville, KY
  • FORTNA partners with the world's leading brands to transform omnichannel and parcel distribution operations. Known world...
  • 4/19/2024 12:00:00 AM

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Client Service Representative
  • Old National Bank
  • Louisville, KY
  • Overview: Old National Bank has been serving clients and communities since 1834. With $48 billion in total assets, we ar...
  • 4/18/2024 12:00:00 AM

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Therapist
  • Aster Springs Outpatient
  • Jeffersonville, IN
  • ***$5000.00 Sign-on and Retention Bonus Available for Qualified Candidates!*** Why You Will Love Working With Us! At Ast...
  • 4/18/2024 12:00:00 AM

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Administrative Assistant
  • Acro Service Corp
  • Jeffersonville, IN
  • The Administrative Assistant is responsible for providing administrative support for the daily operations of the Spider ...
  • 4/18/2024 12:00:00 AM

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Nurse Practitioner - Advanced Practice Provider
  • Oak Street Health Inc.
  • Louisville, KY
  • Title: Nurse Practitioner - Advanced Practice Provider Schedule: Full-Time, Monday through Friday, 8:00 AM - 5:00 PM Loc...
  • 4/17/2024 12:00:00 AM

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Center Medical Director
  • Oak Street Health Inc.
  • Louisville, KY
  • Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quali...
  • 4/17/2024 12:00:00 AM

Louisville and Jefferson County have a combined area of 397.68 square miles (1,030.0 km2), of which 380.46 square miles (985.4 km2) is land and 17.23 square miles (44.6 km2) (4.33%) is covered by water. Louisville is southeasterly situated along the border between Kentucky and Indiana, the Ohio River, in north-central Kentucky at the Falls of the Ohio. Although situated in a Southern state, Louisville is influenced by both Southern and Midwestern culture. It is sometimes referred to as either one of the northernmost Southern cities or as one of the southernmost Northern cities in the United St...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Director jobs
$165,864 to $214,284
Louisville, Kentucky area prices
were up 1.2% from a year ago

Provider Network Director in Moline, IL
You can keep costs low when using your plan by staying “in network,” or using the doctors and other health care providers that are in your plan’s network.
December 27, 2019
Provider Network Director in Sacramento, CA
A healthcare provider network is a compilation of all doctors, physicians, hospitals, clinics, pharmacies, etc.
February 22, 2020
Provider Network Director in Springfield, OR
If the plan name includes any of the following things, your plan does NOT use the standard network.
February 12, 2020