Delta Dental of Missouri
Provider Relations Network Manager
Delta Dental of Missouri, St Louis, Missouri, United States
Job Title: Provider Relations Network Manager
Job Code: E1033
Reports To: Dental Director
FLSA Status: Exempt
Grade Level: 29
Last Updated: October 2024
Position Summary: The primary responsibility of the Provider Relations Network Manager is to provide strategic leadership to achieve the goals of expanding and retaining the provider network. This position tracks and analyzes short-term and long-term performance indicators to identify trends and areas for improvement. Additionally, this position identifies opportunities for process improvements in their department and across the enterprise. This role is often a strategic member of enterprise-wide projects or company initiatives.
The Provider Relations Network Manager manages the department budget and approves all discipline or termination decisions for Provider Relations Representatives. Essential Functions and Job Responsibilities:
1. Provides strategic leadership to the department to expand and retain members of the provider network through exceptional provider experiences. This work may include but is not limited to: • Setting network goals, objectives and strategies to align with the organization's strategic plan and performance measures; • Developing and implementing plans to create the ideal provider experience and achieve key performance indicators (KPIs); • Identifying challenges and opportunities within the network on a proactive basis and implementing solutions to drive positive outcomes and mitigate risks; • Managing the department budget and approving department expenses to meet the financial objectives of the organization; • Creating a strategic plan for facilitating in-person visits of key providers in the network based on utilization and members present in the practice; • Championing continuous improvement efforts, fostering innovation and creativity within the team to enhance service delivery and provider satisfaction.
2. Provides coaching and development to Provider Relations Representatives. This work may include but is not limited to: • Conducting weekly coaching conversations to ensure development of team members; • Fostering a positive and motivating work environment by recognizing and rewarding achievements and providing constructive feedback; • Creating a culture of continuous learning and professional development; • Conducting performance reviews and performance management discussions with direct reports; • Creating development plans and documentation for tracking performance, setting expectations and ensuring compliance with all applicable employment laws; • Completing quarterly check-ins with team members to ensure progression of individual development plans; • Conducting all disciplinary actions including terminations within the department.
3. Tracks and analyzes short-term and long-term key performance indicators (KPIs) to ensure team success in meeting annual goals. This work may include but is not limited to: • Creating a strategic plan for facilitating in-person visits of key providers in the network based on utilization and member size; • Generating and analyzing regular reports on provider network metrics, identifying trends and areas for improvement; • Establishing benchmarks and performance standards for Provider Relations Representatives; • Recommending and executing strategic solutions to ensure goals and metrics are achieved; • Utilizing advanced analytics tools and methodologies to forecast future performance trends and proactively address potential challenges; • Monitoring industry best practices and technological advancements to continually optimize the provider experience and KPI performance; • Presenting KPI insights and recommendations to senior management and key stakeholders to inform strategic decision-making processes; • Developing and maintaining a culture of accountability and continuous improvement within the department; • Meeting or exceeding key metrics as outlined in team and individual goals.
4. Identifies opportunities for process improvement and implements changes to enhance efficiency and effectiveness. This work may include but is not limited to: • Implementing automation solutions to reduce manual workload and increase operational efficiency; • Leading cross-functional teams to design and implement process improvement initiatives; • Benchmarking processes against industry standards and best practices to identify areas for improvement and maintain competitiveness; • Collaborating with other departments to streamline workflows or implement company initiatives.
5. Supports PR Representatives in building relationships and resolving issues with escalated, complex or high priority providers. This work may include but is not limited to: • Reviewing and approving exception items on provider agreements; • Providing coaching on escalations and exceptions to empower team members; • Addressing provider concerns and new developments in the business; • Scripting talking points to address provider concerns or new developments with the business; • Engaging with key providers to further enhance the provider experience.
6. Participates as a strategic member on project teams and task forces for company initiatives. This work may include but is not limited to: • Providing valuable input and insights from the Provider Relations perspective during the planning and execution phases of company-wide projects and initiatives; • Sharing routine updates to other departments to highlight strengths and challenges of the provider experience in a professional manner; • Collaborating with cross-functional teams to ensure that provider requirements and considerations are integrated into project plans and timelines; • Leveraging data and analytics to inform project decision-making and identify opportunities for synergy or integration with existing operations; • Championing the implementation of project deliverables within the Provider Relations department, ensuring that staff are trained and equipped to support new processes or systems effectively; • Monitoring project progress and milestones, identifying potential risks or obstacles impacting the provider network, and proactively proposing solutions or mitigation strategies.
7. Develops relationships with managers of other departments to ensure strong collaboration and resolve process challenges. This work may include but is not limited to: • Meeting formally and informally with peers from other departments to build rapport, share best practices and understand business trends; • Providing routine updates to other departments highlighting feedback from providers on strengths and challenges of service in a professional manner; • Fostering positive relationships with managers and team leads from other departments to understand their needs, challenges and opportunities to innovate; • Providing support and assistance to managers from other departments when they encounter challenges related to provider relations; • Establishing trust and credibility with managers from other departments through open communication, reliability, and a commitment to mutual success.
Regular and reliable attendance is required.
Other duties and responsibilities may be assigned.
Qualifications: • 5+ years’ experience in the dental industry, insurance or financial services field preferred; • 5+ years’ leadership experience; • Experience providing coaching, feedback or mentorship to team members; • Advanced problem-solving and decision-making abilities; • Exceptional verbal and written communication skills; • Detail-oriented with a commitment to accurate documentation.
Competencies: • Appreciation & Recognition • Business Acumen • Change Champion • Coaching • Confidentiality • Delegation • Interpersonal Awareness • Leads for High Performance • Organizational Savvy • Strategic Vision
Environment: This position currently functions as a hybrid role working from both home and in-office environments. Any home office setting must be conducive to all guidelines outlined by the organization. This role is required to regularly attend in-person meetings, the frequency of which is determined by management based on departmental or organizational needs.
Physical and Other Demands: Specific vision abilities required by this job include the ability to adjust focus. While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee is frequently required to use hands and arms to handle, feel, reach and operate a computer. This job requires substantial typing. DDMO provides reasonable accommodation to qualified individuals with a known disability unless doing so imposes an undue hardship.
Employees must be able to successfully perform the essential functions of this role with or without a reasonable accommodation.
Disclaimer: This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties or responsibilities that will be required. The organization reserves the right to modify this job description at any time; including assigning or reassigning job duties or deleting this position at any time.
Position Summary: The primary responsibility of the Provider Relations Network Manager is to provide strategic leadership to achieve the goals of expanding and retaining the provider network. This position tracks and analyzes short-term and long-term performance indicators to identify trends and areas for improvement. Additionally, this position identifies opportunities for process improvements in their department and across the enterprise. This role is often a strategic member of enterprise-wide projects or company initiatives.
The Provider Relations Network Manager manages the department budget and approves all discipline or termination decisions for Provider Relations Representatives. Essential Functions and Job Responsibilities:
1. Provides strategic leadership to the department to expand and retain members of the provider network through exceptional provider experiences. This work may include but is not limited to: • Setting network goals, objectives and strategies to align with the organization's strategic plan and performance measures; • Developing and implementing plans to create the ideal provider experience and achieve key performance indicators (KPIs); • Identifying challenges and opportunities within the network on a proactive basis and implementing solutions to drive positive outcomes and mitigate risks; • Managing the department budget and approving department expenses to meet the financial objectives of the organization; • Creating a strategic plan for facilitating in-person visits of key providers in the network based on utilization and members present in the practice; • Championing continuous improvement efforts, fostering innovation and creativity within the team to enhance service delivery and provider satisfaction.
2. Provides coaching and development to Provider Relations Representatives. This work may include but is not limited to: • Conducting weekly coaching conversations to ensure development of team members; • Fostering a positive and motivating work environment by recognizing and rewarding achievements and providing constructive feedback; • Creating a culture of continuous learning and professional development; • Conducting performance reviews and performance management discussions with direct reports; • Creating development plans and documentation for tracking performance, setting expectations and ensuring compliance with all applicable employment laws; • Completing quarterly check-ins with team members to ensure progression of individual development plans; • Conducting all disciplinary actions including terminations within the department.
3. Tracks and analyzes short-term and long-term key performance indicators (KPIs) to ensure team success in meeting annual goals. This work may include but is not limited to: • Creating a strategic plan for facilitating in-person visits of key providers in the network based on utilization and member size; • Generating and analyzing regular reports on provider network metrics, identifying trends and areas for improvement; • Establishing benchmarks and performance standards for Provider Relations Representatives; • Recommending and executing strategic solutions to ensure goals and metrics are achieved; • Utilizing advanced analytics tools and methodologies to forecast future performance trends and proactively address potential challenges; • Monitoring industry best practices and technological advancements to continually optimize the provider experience and KPI performance; • Presenting KPI insights and recommendations to senior management and key stakeholders to inform strategic decision-making processes; • Developing and maintaining a culture of accountability and continuous improvement within the department; • Meeting or exceeding key metrics as outlined in team and individual goals.
4. Identifies opportunities for process improvement and implements changes to enhance efficiency and effectiveness. This work may include but is not limited to: • Implementing automation solutions to reduce manual workload and increase operational efficiency; • Leading cross-functional teams to design and implement process improvement initiatives; • Benchmarking processes against industry standards and best practices to identify areas for improvement and maintain competitiveness; • Collaborating with other departments to streamline workflows or implement company initiatives.
5. Supports PR Representatives in building relationships and resolving issues with escalated, complex or high priority providers. This work may include but is not limited to: • Reviewing and approving exception items on provider agreements; • Providing coaching on escalations and exceptions to empower team members; • Addressing provider concerns and new developments in the business; • Scripting talking points to address provider concerns or new developments with the business; • Engaging with key providers to further enhance the provider experience.
6. Participates as a strategic member on project teams and task forces for company initiatives. This work may include but is not limited to: • Providing valuable input and insights from the Provider Relations perspective during the planning and execution phases of company-wide projects and initiatives; • Sharing routine updates to other departments to highlight strengths and challenges of the provider experience in a professional manner; • Collaborating with cross-functional teams to ensure that provider requirements and considerations are integrated into project plans and timelines; • Leveraging data and analytics to inform project decision-making and identify opportunities for synergy or integration with existing operations; • Championing the implementation of project deliverables within the Provider Relations department, ensuring that staff are trained and equipped to support new processes or systems effectively; • Monitoring project progress and milestones, identifying potential risks or obstacles impacting the provider network, and proactively proposing solutions or mitigation strategies.
7. Develops relationships with managers of other departments to ensure strong collaboration and resolve process challenges. This work may include but is not limited to: • Meeting formally and informally with peers from other departments to build rapport, share best practices and understand business trends; • Providing routine updates to other departments highlighting feedback from providers on strengths and challenges of service in a professional manner; • Fostering positive relationships with managers and team leads from other departments to understand their needs, challenges and opportunities to innovate; • Providing support and assistance to managers from other departments when they encounter challenges related to provider relations; • Establishing trust and credibility with managers from other departments through open communication, reliability, and a commitment to mutual success.
Regular and reliable attendance is required.
Other duties and responsibilities may be assigned.
Qualifications: • 5+ years’ experience in the dental industry, insurance or financial services field preferred; • 5+ years’ leadership experience; • Experience providing coaching, feedback or mentorship to team members; • Advanced problem-solving and decision-making abilities; • Exceptional verbal and written communication skills; • Detail-oriented with a commitment to accurate documentation.
Competencies: • Appreciation & Recognition • Business Acumen • Change Champion • Coaching • Confidentiality • Delegation • Interpersonal Awareness • Leads for High Performance • Organizational Savvy • Strategic Vision
Environment: This position currently functions as a hybrid role working from both home and in-office environments. Any home office setting must be conducive to all guidelines outlined by the organization. This role is required to regularly attend in-person meetings, the frequency of which is determined by management based on departmental or organizational needs.
Physical and Other Demands: Specific vision abilities required by this job include the ability to adjust focus. While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee is frequently required to use hands and arms to handle, feel, reach and operate a computer. This job requires substantial typing. DDMO provides reasonable accommodation to qualified individuals with a known disability unless doing so imposes an undue hardship.
Employees must be able to successfully perform the essential functions of this role with or without a reasonable accommodation.
Disclaimer: This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties or responsibilities that will be required. The organization reserves the right to modify this job description at any time; including assigning or reassigning job duties or deleting this position at any time.