Director, Provider Engagement DentaQuest
Director, Provider Engagement DentaQuest
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$ 129800 - 194700
1 Vacancy
Job Description
Sun Life U.S. is one of the largest providers of employee and government benefits helping approximately 50 million Americans access the care and coverage they need. Through employers industry partners and government programs Sun Life U.S. offers a portfolio of benefits and services including dental vision disability absence management life supplemental health medical stop-loss insurance and healthcare navigation. We have more than 6400 employees and associates in our partner dental practices and operate nationwide.
DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based cost-effective solutions are designed for Medicaid and CHIP Medicare Advantage small and large businesses and individuals. With a focus on prevention and value we aim to make quality care accessible to improve the oral health of all.
Job Description:
Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.
The Opportunity:
The Director Provider Engagement (PE) is responsible for overall provider network experience performance and compliance. The Director strategically analyzes manages and reports on the provider network and related activities regarding all programs and products including Medicaid Medicare Advantage Marketplace and Commercial (and any blend of products e.g. dual eligible) and is responsible for the P&L (cost of care and loss ratio) of the network(s). These duties include but are not limited to the development and oversight of access cost and quality measurements to ensure network compliance client satisfaction sales support optimized provider performance and improved outcomes. The Director maintains ultimate oversight of as
signed provider engagement staff and therefore provides clear direction ongoing education to include professional development and daily activity monitoring tools for reporting purposes. This position interfaces and collaborates with multiple internal operational areas as well as face to face and virtually with clients representing the organization as the network Subject Matter Expert.
How you will contribute:
Oversee the development and execution of as well as provide support and direction to the Provider Engagement team in support of all products
Own applicable P&Ps SOPs SLAs and ensure compliance with them
Develop innovative competitive cost effective and quality networks for all products in support of new sales and existing client retention
Champion provider adoption/utilization of digital platforms/tools
Provide support and direction to the team to ensure appropriate allocation of resources to meet multiple deliverables and participate in a wide range of network focused initiatives
Establish provider network targets recruit/contract new providers and work with existing providers to move them along the cost and quality continuum.
Develop strategies to increase member access preventive care increase quality and outcomes while decreasing costs
Collaborate with other areas to ensure members assignments and dental home programs meet cost quality access and capacity goals
Review and submit for approval special deal requests retroactive adjustments reimbursement and contract exceptions
Use available tools and resources to conduct Network Adequacy Compliance Validation Accuracy Appointment Availability and other related activities as required/needed
Collaborate with other enterprise functions to drive improvements in Provider Data Integrity
Support and assist credentialing to obtain missing credentialing information
Collaborate with Marketing Communications Governmental Relations Clinical and Client teams to position the organization favorably and achieve desired business results
Partner in responding to Request for Proposals (RFPs) to illustrate network strategies as a competitive advantage to grow new business and retain existing business
Strategize with analytics and other teams on best approaches for collection evaluation compilation and dissemination of data consistent with requirements and goals
Assess environmental trends needs and opportunities to inform decision makers internally and externally on opportunities to execute provider programs that achieve annual business goals.
Monitor portfolio of contract operations ensuring successful execution of operating plan objectives and achievement of outcome/success measures for Providers
Develop and manage department budgets and resources consistent with short and long term financial and operational goals
Proactively research competitors provider panels; fee schedule and reimbursement methodologies; policies and procedures; tools and technology; processes etc.; and make recommendations to meet or exceed competition
Build and maintain relationships with leaders of local dental associations FQHCs Public Health dental schools large group practices and other key provider stakeholders
Collaborate with Client team to meet network needs and participate in on-site meetings virtual meetings conference calls and day-to-day interaction with clients prospective clients organized dentistry and other key industry stakeholders
Direct team on the appropriate preparation of client audits CAPs and ad hoc report documents
Oversee other engagement activities and projects related to the provider network
Ensure internal and external network reports are prepared and delivered accurately and timely
Develop solutions to improve participating provider satisfaction and innovative approaches to advance recruitment strategies to attract providers to join all lines of business
Develop and maintain provider reimbursement models in line with cost of care goals market research and profitability/loss ratio objectives using effective negotiating strategies
Draft Provider Agreements Restated Agreements Amendments and other communications as needed and by working with legal and marketing
Organize assess and problem solve workflows with other departments to ensure efficient timely and accurate outcomes
Coordinate and implement appropriate performance management strategies for team members to include:
Assist in the hiring process including interviewing candidates
Assist train and motivate team members to Evaluate and measure effectiveness of team members
Assist in preparation of performance and wage evaluations in accordance to company policy
Responsible for attendance and company approved time off for team members
Participate in the determination and implementation of Performance Improvement Plans and performance management initiatives.
Design reports to effectively manage team members
Train and coach team to be knowledgeable in all aspects of their role and responsibilities
Other duties as assigned.
What you will bring with you:
Bachelors degree in business healthcare administration or related/applicable degrees e.g. marketing communications finance etc.
Ten (10) years of related experience in management with experience in business or healthcare administration finance or another related field preferred
Ten (10) years of demonstrated leadership in the development monitoring and successful implementation of organizational strategy
Ten (10) years of experience in client and provider relationship management
Five (5) years of experience in process or operational management
The ability to think analytically decipher and understand complex data
The ability to design and manage complex organizational policies and communications and obtain corporate and divisional cross functional support
The ability to design and manage complex organizational policies and communications
Ability to manage multiple projects simultaneously
Comprehensive knowledge of the healthcare industry and payment methodologies including Value Based or Alternative Payment Models
Demonstrated skill in recruiting training coaching managing motivating and developing staff
Demonstrated skill in financial and budget management
Executive-level written and verbal communication presentation interaction and persuasive skills
Demonstrated skill in high-level decision-making and problem-solving
Proficiency with general computer software (Excel Word and PowerPoint)
Ability to work in a fast-paced results-driven environment
Salary:
Salary Range: $129800 - $194700
At our company we are committed to pay transparency and equity. The salary range for this role is competitive nationwide and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills qualifications experience education and geographic addition to your base salary this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.
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We are committed to fostering an inclusive environment where all employees feel they belong are supported and empowered to thrive. We are dedicated to building teams with varied experiences backgrounds perspectives and ideas that benefit our colleagues clients and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.
Life is brighter when you work at Sun Life
At Sun Life we prioritize your well-being with comprehensive benefits including generous vacation and sick time market-leading paid family parental and adoption leave medical coverage company paid life and AD&D insurance disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match stock purchase options and an employer-funded retirement account. Enjoy a flexible inclusive and collaborative work environment that supports career growth. Were proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S. weve also been recognized as a Top 10 employer by the Boston Globes Top Places to Work for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.
We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans unless the accommodation would impose an undue hardship on the operation of our business. Please email to request an accommodation.
For applicants residing in California please read our employee California Privacy Policy and Notice.
We do not require or administer lie detector tests as a condition of employment or continued employment.
Sun Life will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of applicable state and local laws including applicable fair chance ordinances.
All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or status as a protected veteran.
Job Category:
Posting End Date:
Required Experience:
Director
Employment Type
Full-Time
