Director of Provider Engagement

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

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:

Location: We support US flexible working arrangements in the contiguous 48 states.

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.

The opportunity:

The Director, Provider Engagement (PE) is accountable 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 eligibles), and handles 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 assigned 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 assistance 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 aid 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 motivation 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
  
  

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.

Not ready to apply yet but want to stay in touch? Join our talent community (https://pages.beamery.com/sunlifecareers/page/join-us-canada) to stay connected until the time is right for you!

Life is brighter when you work at Sun Life

• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
• A flexible work environment with a friendly, caring, collaborative and inclusive culture
• Great Place to Work® Certified in Canada and the U.S.
• Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running
  
  

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.

If you are a California resident, the salary range for this position is:

• Southern California region: $130,300 - $195,500 annually
• Central California region: $137,400 - $206,100 annually
• Northern California region: $146,900 - $220,400 annually
  
  

If you are a Colorado or Nevada resident, the salary range for this position is $124,400 - $186,600 annually

If you are a Connecticut or Maryland resident, the salary range for this position is $130,300 - $195,500 annually

If you are Washington or Rhode Island resident, the salary range for this position is $137,400 - $206,100 annually

If you are a New York resident, the salary range for this position is $146,900 - $220,400 annually

We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation 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 [email protected] to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

Job Category:

Dental Network

Posting End Date:

30/07/2024

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