- Masters degree in relevant field
- 5-10 years in managed care experience, QI experience, or Provider network management
- 3-5 year's experience relating to compliance activities (HIPAA, Medicare Advantage, etc.)
- Solid project management skills, data product management skills and ability to oversee complex data management processes.
- Basic understanding of NCQA and credentialing processes.
- Excellent communication skills
- Strong leadership ability
- Significant knowledge and experience in CQI principles
- Thorough knowledge of hospital and physician (multi-specialty group, IPA or PHO) operations and services impacted by managed care.
- Basic knowledge of HIPAA privacy and Security rules.
- Thorough knowledge of the managed care industry.
- Familiarity with clinical measurements
- Knowledge of QI Systems
- Self-motivated, highly organized, detail-oriented, positive professional with relationship-building skills.
- Able to travel to other hospital sites, corporate settings and seminar locations.
- Work will often require long hours, including late night and early morning meetings
- Able to work under stressful conditions and manage multiple competing priorities
- Able to communicate with diverse groups of customers and diffuse difficult situations
To plan, organize and direct APP-wide functions for physician network management, credentialing and compliance with direct impact to Advocate Health Care. This position is accountable for supporting the goals and objectives of Advocate Physician Partners while directly managing the membership and performance requirements of APP member physicians including the oversight of all network adequacy and development under each managed care contracts.
This position works directly with the Center for Provider Information and oversees the requirements for managed care contract credentialing and providing required information and data about the APP physicians to contracted payers. In addition the director will be working closely with Advocate legal and compliance departments, ensuring that Advocate Physician Partners meets all contractual and regulatory compliance requirements, including those required by government (Medicare and Medicaid) payer contracts. Overall, this position is responsible for the direction of multiple priorities that impact patient care, quality, cost and physician and patient satisfaction.
- Responsible for directing all Network Management for APP, including AHC Corporate Compliance Activities
- Payer Contract Compliance
- Direction and Oversight of all APP Provider information.