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Director, Provider Relations

Job in Clifton, Passaic County, New Jersey, 07015, USA
Listing for: Benecard Services, LLC
Full Time position
Listed on 2025-12-01
Job specializations:
  • Healthcare
    Healthcare Management, Healthcare Administration
  • Management
    Healthcare Management
Job Description & How to Apply Below

Under the direction of the Vice President, Provider Relations, the Director of Provider Relations is responsible for establishing, maintaining, and growing strategic relationships with providers, ensuring a collaborative partnership that enhances the quality of care. Supports the organization's growth goals, initiatives, and strategic priorities. Works effectively to improve the experience for referring providers and collaborates with leadership to implement organizational strategies.

Prepares various reports on network needs and service coverage, performs quality checks to ensure the integrity of systemic provider files, and provides trend analysis. Also responsible for all Provider Communications and Training activities.

Must report on site in New Jersey 5 days a week.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To be successful, an individual must be able to perform each essential duty and responsibility satisfactorily.

  • Work closely with the Vice President to develop and implement a comprehensive provider relations strategy to foster strong partnerships with key providers and retail providers, including a strategic plan for network reimbursements.
  • Act as liaison between the NVA and healthcare providers, addressing inquiries, concerns, and feedback.
  • Create and maintain a customer service model for internal and external customers.
  • Identify opportunities for new partnerships and negotiate contracts with healthcare providers with the Vice President.
  • Analyze market trends and provider network performance to inform strategic decisions.
  • Ensure compliance with regulatory requirements, as applicable, and industry standards.
  • Manage ongoing provider communications (ECP and Retail).
  • Initiate and implement processes to ensure the website and provider directory contain current information.
  • Create and maintain databases for enrollment, complaints, etc., and provide trend analysis.
  • Create Policies and Procedures that control network functions.
  • Communicate pertinent provider issues to applicable internal customers and the Vice President.
  • Create and maintain all provider manuals.
  • Develop templates and manage Plan Sheets, including creation of manual sheets.
  • Manage the provider wake-up process, including drafting and coordinating mailing letters based on group demographics.
  • Own any Internal Improvement Plans (IIPs) related to department functions.
  • Oversee multiple projects simultaneously.
  • Other duties as assigned.
  • SUPERVISORY RESPONSIBILITIES:

    Responsible for supervising Credentialing and Provider Recruitment Teams (3-5 employees) and others as necessary.

    QUALIFICATION REQUIREMENTS:
    • Bachelor’s degree in business or related healthcare management field. Significant additional experience may be considered in lieu of a degree with some college.
    • Minimum of 5 years’ experience in Network Management and Relationship Development within Healthcare Plans and Providers, in a managed care or vision company.
    • Excellent oral and written communication skills, with the ability to communicate effectively with all customers.
    • Computer skills with Microsoft Office, including MS Word, Excel, PowerPoint, Access, and Outlook.
    • Demonstrated leadership skills.
    • Strong organizational, analytical, and problem-solving skills.
    • Ability to multi-task effectively among multiple activities.
    • Willingness to travel as required.
    Seniority level
    • Director
    Employment type
    • Full-time
    Job function
    • Business Development and Sales
    Industries
    • Pharmaceutical Manufacturing
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