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Director Provider Account Management

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One Call

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Location:
United States

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Category:
Health and Beauty

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Contract Type:
Not provided

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Salary:

86000.00 - 141800.00 USD / Year
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Job Description:

JOB SUMMARY: Responsible for leading growth, maintenance and implementation of cost-effective provider contracting arrangements. This includes network strategies and strategic account management for our national network of providers. Serves as leader to the manager and Provider Account Management personnel, overseeing the development of network-wide strategies, contracts, and strategic accounts to improve efficiency and drive revenue growth. Under the direction of the Vice President, Provider Networks, s/he performs all critical functions necessary to assess, develop, maintain and/or improve provider contract/Account adequacy and performance.

Job Responsibility:

  • Direct team activities while working with the manager on items, including Key Account updates, cross functional projects, savings initiatives, revenue growth, and new product opportunities
  • Guide the manager in working with team to maintain critically important providers, integrated provider systems, and provider networks that support business needs and align with corporate priorities while working to identify gaps in coverage with a plan to address
  • Support the manager leading the team in building and maintaining productive relationships with key accounts while enforcing One Calls value propositions in the marketplace
  • Lead Managers in reporting and forecasting key operational functions and data analyses necessary to support provider contracts/current key accounts so the One Call’s work units can create complete, timely, and accurate workflows and support for provider networks and contractual provisions working with team to ensure they are as effective as possible
  • Meet with managers to discuss/report up on any potential regulatory changes, analyze contractual language periodically, as well as the parties' obligations and overall relationships to ensure agile response to market conditions, necessary regulatory compliance, and adequate network access
  • Support manager to share and maintain thorough knowledge of existing and emerging contract arrangements, regulations, and pricing trends
  • renegotiate contracts where improvements are needed
  • Lead and meet with managers on regular cadence to monitor contract performance of providers
  • analyze relevant reports
  • identify reporting, administration, reconciliation, and systems opportunities for improvement
  • and recommend enhancements so contracts can be administered accurately, and ongoing provider performance can be effectively measured
  • Support manager on cross functional teams/discussions to review and identify new opportunities for revenue growth and savings, maintaining open communication and providing consistent updates to key stakeholders
  • Report out to VP/ExCo any SWOT (Strengths, Weaknesses, Opportunities, Threats) that could have impact on business and work with managers to coordinate response teams
  • Work with manager, for reporting purposes, to prepare and present current target accuracy on specific goals and issue trends to team during regularly scheduled performance reviews to maintain year-end financial goals
  • Lead efforts to address escalated issues, working directly with VP/ExCo level to ensure challenges are identified, resolution is put in place and monitoring for closure
  • Support manager and team as needed during annual business reviews with key accounts, providing assistance and information to further strengthen relationships
  • Work with manager to identify/review key strategic providers and execute contract amendments, to include new locations, modalities, and services lines
  • Additional duties as assigned/business needs require

Requirements:

  • Bachelor’s degree (B.A. or B.S.) and/or a Master’s degree (M.A., S. or M.B.A.) in Business or Accounting
  • Minimum of five (5) years of experience in health care services
  • Three (5) years of management experience
  • Five (5) years of experience in provider relations and/or Account/vendor Management, or a related area
  • A combination of equivalent education or experience
  • Minimum of 10 years of successful provider contracting and/or Account Management experience including: Excellent provider relations experience and thorough knowledge of managed care practices and provider contracting, either in a provider or payor capacity
  • Extensive experience and thorough knowledge of provider reimbursement methodologies, financial modeling, business analytics and reporting, provider coding and billing procedures, and related concepts and terminology
  • Thorough knowledge of insurance terminology, concepts, and benefits issues, including actuarial and underwriting relationships to provider rates and services, member benefits, and cost sharing attributes
  • Excellent verbal communication skills, including listening effectively, persuasive negotiation skills, and communicating strategic and technical issues to individuals and in presentations to groups
  • Ability to comprehend and interpret managed care contract terminology and thorough knowledge of quantitative analysis related to provider reimbursement
  • Experience articulating and representing a compelling vision of an organization's strategic direction with provider relationships
  • Management experience demonstrating effective leadership that results in achievement of desired results
  • Ability to work in an environment that aligns with the company's diversity, equity, inclusion and belonging standards
  • Ability to work both independently and as part of a team in a fast-paced environment
  • Demonstrate our core values of Think Big, Go Fast, Deliver Awe, Win Together, and Care Deeply

Additional Information:

Job Posted:
May 17, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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