Oversees the development and implementation of VNSNY CHOICE Provider Relations, which includes the orientation and servicing of Non-Traditional Providers and Home and Community Based Providers. Ensures compliance with all state and federal regulations, as well as VNSNY CHOICE policies and procedures. Works under general direction.
- Collaborates with CHOICE leadership to identify provider management opportunities that support achievement of increased quality and efficiency. Identifies and recommends best practices for operational improvements and performance.
- Collaborates with CHOICE Health Plan leadership to review provider performance and identify unmet service needs to ensure overall satisfaction.
- Participates in the oversight of relationships, ensuring performance metrics are achieved and identifying and implementing opportunities for improvement.
- Directs LTC provider recruitment activity. Works with Network Development management to identify providers and develop provider recruitment and orientation strategies based on network requirements of each product line. Oversees the recruitment process to identify and establish relationships with various service providers.
- Ensures ongoing communication with providers through phone contact and site visits. Sets daily, weekly, monthly and annual provider site visit targets and ensures they are being met. Reports on departmental activity.
- Identifies common issues affecting provider networks; works with Account Management staff and health plan colleagues in developing solutions.
- Ensures compliance with all regulatory reporting requirements to SDOH and CMS.
- Maintains visibility in the provider community by attending provider-sponsored events, seminars and conferences.
- Works with Quality and Clinical Management Department to ensure quality assurance monitoring of network providers.
- Keeps abreast of current industry trends, governing regulations, reimbursement practices and market players. Keeps VNSNY CHOICE management informed of trends/changes and makes recommendations based on this information.
- Performs all duties inherent in a senior managerial role. Approves staff training, hiring, promotions, terminations, and salary actions. Prepares and ensures adherence to department budget.
- Participates in special projects and performs other related duties as assigned.
Education: Bachelor’s Degree in Business, Health Administration, Health Policy or related discipline required. Master’s degree in Business, Health Administration, Health Policy or related discipline required.
Experience: Minimum eight years of experience in health care, with a minimum five years in a managed care environment and four years in health care management required. Experience working with network service providers and negotiating/administering contracts required.
The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life. Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 44,000 patients and members, helping them to live the best lives possible in their homes and communities.