Provider Relations Manager

Function(s): Responsible for supervision of Provider Relations Specialists and PQI staff, compliance activities, provider recruitment and retention. This position supports the overarching strategy for adequate provider network in order to assure quality services to the Agency’s consumers and members. JOB RESPONSIBILITIES: (Group/list job duties by functional area.) Responsible for supervision of Provider Relations Specialists and programmatic compliance activities 1. Oversees daily activities of Provider Relations Specialists and PQI division 2. Ensure Agency staff and provider compliance with applicable regulatory policies, procedures and rules. 3. Oversees and assures: A. Quality of structural and service specification reviews of providers in compliance with program administrative standards and requirements. B. Service quality and client satisfaction through chart reviews, home visits and telephone interviews. 4. Provides support and/or technical assistance to: A. Providers to enhance provider compliance within Medicaid and non-Medicaid program standards and requirements. B. Agency staff regarding provider and client issues. C. The general community in response to requests for data, information about programs, requirements, and processes. 5. Performs quality assurance reviews of staff compliance and documentation Responsible for adequate provider network through provider recruitment and retention activities 6. Cultivates relationships with current and future Medicaid and non-Medicaid Providers 7. Educates and informs current and potential providers about Agency programs and services 8. Oversees appropriate and timely intervention/communication when providers have issues or complaints 9. Ensures appropriate cross-departmental communication of provider service initiatives and contracted network provider issues 10. Designs and implements programs to build and nurture positive relationships between contracted providers and the Agency 11. Develops and implements strategies to reduce member and consumers access grievances with contracted providers. 12. Develops and implements strategies to increase provider engagement in quality initiatives 13. Responsible for the successful development and maintenance of the agency’s provider network 14. Develops and maintains contract database and disseminates communications to providers as necessary 13. Aggregates and analyzes provider data from various sources to recommend and implement solutions to assist with provider collaboration activities 14. Recruits new Medicaid and non-Medicaid providers 15. Assures that provider contracts are executed and maintained according to the Agency’s policies 16. Develops and fosters relationships with the Ohio Department of Aging (ODA) and other oversight agencies and/or entities Other Duties 17. Prepares departmental reports as required. 18. Participates in Agency Speaker’s Bureau. 19. Identifies and implements LEAN process engineering activities. 20. Participates in the development and implementation of the local performance culture. 21. Exemplifies the Agency 3C’s corporate culture in all activities and interactions with staff, members, consumers, stakeholders as well as the community at large. 22. Maintains minimum proficiency in all requisite computer applications and software. 23. Participates in the implementation of strategic business and/or operational plans, projects, programs and systems as appropriate for the objectives. 24. Participates in and contributes towards accomplishment of divisional and Agency dashboard goals. 25. Performs other tasks as assigned by supervisor. · Pre-employment drug & nicotine testing required · Annual influenza vaccination is required EOE Employer We celebrate diversity and embrace everyone regardless of age, gender, disability, race, ethnicity, creed, national origin, religion, sexual orientation or other characteristics. And we actively foster a diverse and inclusive environment through the care we offer and the people we employ. Direction Home is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class. Job Type: Full-time Pay: $78,100.00 - $94,800.00 per year Benefits: 401(k) Dental insurance Employee assistance program Flexible spending account Health insurance Life insurance Paid time off Paid training Vision insurance Schedule: Day shift Monday to Friday Ability to Relocate: Uniontown, OH 44685: Relocate before starting work (Required) Work Location: Hybrid remote in Uniontown, OH 44685