Director-Provider Services-Health Plan (remote/hybrid)
Presbyterian Healthcare Services · Albuquerque, NM · 1 mo ago
Full-time
We need to output HTML fragment with headings for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We have:
- About the role: The summary paragraph after "Summary". That's content.
- Responsibilities: The "Job Description Responsibilities" bullet list.
- Requirements: The "Additional Job Description" includes education/experience requirements. Could be Requirements.
- Qualifications: Might be similar to Requirements; but we need to decide. The posting includes "Bachelor’s degree or 6 years of additional experience can be substituted in lieu of degree. A minimum of 10 years experience..." That's qualifications/requirements. Could put under Requirements.
- Skills: There's mention of strong communication, financial and analytics, business acumen, etc. Could be Skills.
- Benefits: There's a Benefits section with list.
- Pay: Not specified; no pay info. So omit Pay.
- Schedule: Work Arrangement info: Remote open to US except certain states; Hybrid strongly preferred for within 60 miles of Albuquerque, in-office presence required Tuesday through Thursday. That's schedule info. So include Schedule.
We must not repeat job title as heading. No Job ID etc.
We must remove boilerplate: AA/EOE..., etc. Also remove "About Us", "About New Mexico" maybe? Those are not required sections; but we could include as "About the role"? Actually "About Us" is company description; not required heading. We could omit because not in allowed headings list. The instruction: Use
for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We have:
- About the role: The summary paragraph after "Summary". That's content.
- Responsibilities: The "Job Description Responsibilities" bullet list.
- Requirements: The "Additional Job Description" includes education/experience requirements. Could be Requirements.
- Qualifications: Might be similar to Requirements; but we need to decide. The posting includes "Bachelor’s degree or 6 years of additional experience can be substituted in lieu of degree. A minimum of 10 years experience..." That's qualifications/requirements. Could put under Requirements.
- Skills: There's mention of strong communication, financial and analytics, business acumen, etc. Could be Skills.
- Benefits: There's a Benefits section with list.
- Pay: Not specified; no pay info. So omit Pay.
- Schedule: Work Arrangement info: Remote open to US except certain states; Hybrid strongly preferred for within 60 miles of Albuquerque, in-office presence required Tuesday through Thursday. That's schedule info. So include Schedule.
We must not repeat job title as heading. No Job ID etc.
We must remove boilerplate: AA/EOE..., etc. Also remove "About Us", "About New Mexico" maybe? Those are not required sections; but we could include as "About the role"? Actually "About Us" is company description; not required heading. We could omit because not in allowed headings list. The instruction: Use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we should only use those headings. So we should not include About Us or About New Mexico. So we will omit those.
We need to preserve all substantive information from the posting, but we can omit boilerplate and duplicated lines. We need to include the summary, responsibilities, requirements/qualifications/skills, benefits, schedule.
We need to decide how to split content into sections.
Let's extract:
Summary: "The Director of Provider Network Servicing and Value-Based Payments is a senior leadership role responsible for the strategic oversight, performance, and integration of provider servicing operations and value-based payment (VBP) programs across all lines of business. This role ensures a high-performance provider network by driving operational excellence in provider engagement, issue resolution, and education, while advancing the transition to value-based care through effective program design, implementation, and performance management. The position partners closely with Provider Contracting, Medical Economics, Clinical Operations, and Finance to optimize total cost of care, improve quality outcomes, and strengthen provider relationships."
That's About the role.
Responsibilities: list items from "Job Description Responsibilities". Let's capture each bullet:
- Lead all aspects of provider servicing operations, including issue resolution, provider education, and ongoing relationship management.
- Serve as the escalation point for complex provider issues, ensuring timely resolution and root-cause remediation.
- Establish standardized servicing models, workflows, and performance expectations across servicing teams.
- Collaborate on provider communication strategies, including outreach, training, and engagement initiatives.
- Lead cross-functional efforts to resolve systemic provider issues involving claims, configuration, and payment accuracy.
- Provide strategic leadership for value-based payment programs, including shared savings, capitation, pay-for-performance, and alternative payment models.
- Oversee design, implementation, and ongoing optimization of VBP arrangements across key provider segments (e.g., primary care, large systems, specialists).
- Partner with Medical Economics to develop financial models, performance benchmarks, and incentive methodologies.
- Ensure alignment between contracting strategies and value-based program objectives.
- Drive provider adoption and maturation along the value-based continuum through education, analytics, and performance reporting.
- Establish performance measurement framework for provider quality, utilization, and total cost of care.
- Oversee development of provider-facing dashboards and internal reporting to monitor VBP and network performance.
- Leverage data analytics to inform provider engagement strategies and financial optimization opportunities.
- Oversee implementation and monitoring of payment models, ensuring accurate configuration and performance tracking.
- Evaluate financial performance of contracts and VBP programs, including impact on Medical Cost Ratio (MCR) and trend.
- Support negotiation strategy by providing insights on provider performance and operational risks.
- Ensure all provider servicing and VBP activities comply with federal, state, and accreditation requirements (e.g., CMS, Medicaid, NCQA).
- Support regulatory reporting and audits related to provider network operations and value-based arrangements.
- Maintain policies and procedures governing provider servicing and VBP operations.
- Build and maintain strategic relationships with key provider organizations and executive stakeholders.
- Lead Joint Operating Committees (JOCs) and provider governance forums.
- Serve as a senior liaison between the health plan and provider community.
- Drive continuous improvement in provider servicing workflows, tools, and technology platforms.
- Partner with IT and analytics teams to enhance provider data, reporting, and automation capabilities.
- Lead transformation initiatives linking provider servicing with population health and clinical operations.
- Lead and develop high-performing teams across provider servicing and VBP functions.
- Establish clear goals, KPIs, and accountability structures aligned with organizations priorities.
- Foster a culture of collaboration, innovation, and continuous improvement.
That's a lot.
Requirements: The "Additional Job Description" paragraph: "Bachelor’s degree or 6 years of additional experience can be substituted in lieu of degree. A minimum of 10 years experience in provider relations, provider contracting, claims processing, correct coding, and customer service in a managed care organization including 5 years of progressive leadership experience. Strong understanding of reimbursement methodologies (FFS, capitation, shared savings, risk-based models) Must possess strong communication skills and be comfortable with public speaking. Excellent financial and analytics as well as business acumen and familiarity with the operations of sophisticated large integrated delivery systems, innovative business models, managing of a complex multi-institutional and multi-market environment, joint ventures, and evolving population health and payment models. Ability to inspire, influence and lead change in difficult and complex environments. Knowledge of current national health care policies and trends, as well as leadership, management, and quality improvement concepts."
We could split into Requirements (education/experience) and Skills (communication, financial analytics, etc.). But we can also combine. The instruction: prefer a few substantive sections over many thin ones. So we could have Requirements covering education/experience and core competencies, and Skills covering specific abilities. But we need to decide.
We have also "Qualifications" maybe same as Requirements. Let's make:
- Requirements: education/experience, years, understanding of reimbursement methodologies.
- Skills: strong communication, public speaking, financial and analytics, business acumen, ability to inspire/influence/lead change, knowledge of national health care policies, leadership/management/QI concepts.
We could also include "familiarity with operations of sophisticated large integrated delivery systems..." as skill.
We'll produce two sections: Requirements and Skills.
Benefits: list from Benefits section.
Schedule: from Work Arrangement.
Now we need to output HTML fragment with headings and - for lists,
for prose.
We must not include any extra text outside HTML.
Let's craft.
First, About the role:
About the role
...summary...
Second, Responsibilities: Responsibilities
- ... each bullet ...
Third, Requirements: Requirements
... education/experience and understanding of reimbursement methodologies ...
Fourth, Skills: Skills
- ... each skill bullet ...
Fifth, Benefits: Benefits
- ... each benefit ...
Sixth, Schedule: Schedule
... work arrangement description ...
We must ensure we don't include headings with empty content.
Now let's write the content precisely.
About the role paragraph: combine the summary sentences.
"The Director of Provider Network Servicing and Value-Based Payments is a senior leadership role responsible for the strategic oversight, performance, and integration of provider servicing operations and value-based payment (VBP) programs across all lines of business. This role ensures a high-performance provider network by driving operational excellence in provider engagement, issue resolution, and education, while advancing the transition to value-based care through effective program design, implementation, and performance management. The position partners closely with Provider Contracting, Medical Economics, Clinical Operations, and Finance to optimize total cost of care, improve quality outcomes, and strengthen provider relationships."
Now Responsibilities list: we need to include each bullet as - . Ensure we keep the exact phrasing.
Let's list them:
1. Lead all aspects of provider servicing operations, including issue resolution, provider education, and ongoing relationship management.
2. Serve as the escalation point for complex provider issues, ensuring timely resolution and root-cause remediation.
3. Establish standardized servicing models, workflows, and performance expectations across servicing teams.
4. Collaborate on provider communication strategies, including outreach, training, and engagement initiatives.
5. Lead cross-functional efforts to resolve systemic provider issues involving claims, configuration, and payment accuracy.
6. Provide strategic leadership for value-based payment programs, including shared savings, capitation, pay-for-performance, and alternative payment models.
7. Oversee design, implementation, and ongoing optimization of VBP arrangements across key provider segments (e.g., primary care, large systems, specialists).
8. Partner with Medical Economics to develop financial models, performance benchmarks, and incentive methodologies.
9. Ensure alignment between contracting strategies and value-based program objectives.
10. Drive provider adoption and maturation along the value-based continuum through education, analytics, and performance reporting.
11. Establish performance measurement framework for provider quality, utilization, and total cost of care.
12. Oversee development of provider-facing dashboards and internal reporting to monitor VBP and network performance.
13. Leverage data analytics to inform provider engagement strategies and financial optimization opportunities.
14. Oversee implementation and monitoring of payment models, ensuring accurate configuration and performance tracking.
15. Evaluate financial performance of contracts and VBP programs, including impact on Medical Cost Ratio (MCR) and trend.
16. Support negotiation strategy by providing insights on provider performance and operational risks.
17. Ensure all provider servicing and VBP activities comply with federal, state, and accreditation requirements (e.g., CMS, Medicaid, NCQA).
18. Support regulatory reporting and audits related to provider network operations and value-based arrangements.
19. Maintain policies and procedures governing provider servicing and VBP operations.
20. Build and maintain strategic relationships with key provider organizations and executive stakeholders.
21. Lead Joint Operating Committees (JOCs) and provider governance forums.
22. Serve as a senior liaison between the health plan and provider community.
23. Drive continuous improvement in provider servicing workflows, tools, and technology platforms.
24. Partner with IT and analytics teams to enhance provider data, reporting, and automation capabilities.
25. Lead transformation initiatives linking provider servicing with population health and clinical operations.
26. Lead and develop high-performing teams across provider servicing and VBP functions.
27. Establish clear goals, KPIs, and accountability structures aligned with organizations priorities.
28. Foster a culture of collaboration, innovation, and continuous improvement.
Check for any duplicates: none.
Now Requirements paragraph: combine education/experience and understanding of reimbursement methodologies.
"Bachelor’s degree or 6 years of additional experience can be substituted in lieu of degree. A minimum of 10 years experience in provider relations, provider contracting, claims processing, correct coding, and customer service in a managed care organization including 5 years of progressive leadership experience. Strong understanding of reimbursement methodologies (FFS, capitation, shared savings, risk-based models)."
Now Skills list: items:
- Must possess strong communication skills and be comfortable with public speaking.
- Excellent financial and analytics as well as business acumen.
- Familiarity with the operations of sophisticated large integrated delivery systems, innovative business models, managing of a complex
headings and - for lists,
for prose.
We must not include any extra text outside HTML.
Let's craft.
First, About the role:
About the role
...summary...
Second, Responsibilities: Responsibilities
- ... each bullet ...
Third, Requirements: Requirements
... education/experience and understanding of reimbursement methodologies ...
Fourth, Skills: Skills
- ... each skill bullet ...
Fifth, Benefits: Benefits
- ... each benefit ...
Sixth, Schedule: Schedule
... work arrangement description ...
We must ensure we don't include headings with empty content.
Now let's write the content precisely.
About the role paragraph: combine the summary sentences.
"The Director of Provider Network Servicing and Value-Based Payments is a senior leadership role responsible for the strategic oversight, performance, and integration of provider servicing operations and value-based payment (VBP) programs across all lines of business. This role ensures a high-performance provider network by driving operational excellence in provider engagement, issue resolution, and education, while advancing the transition to value-based care through effective program design, implementation, and performance management. The position partners closely with Provider Contracting, Medical Economics, Clinical Operations, and Finance to optimize total cost of care, improve quality outcomes, and strengthen provider relationships."
Now Responsibilities list: we need to include each bullet as - . Ensure we keep the exact phrasing.
Let's list them:
1. Lead all aspects of provider servicing operations, including issue resolution, provider education, and ongoing relationship management.
2. Serve as the escalation point for complex provider issues, ensuring timely resolution and root-cause remediation.
3. Establish standardized servicing models, workflows, and performance expectations across servicing teams.
4. Collaborate on provider communication strategies, including outreach, training, and engagement initiatives.
5. Lead cross-functional efforts to resolve systemic provider issues involving claims, configuration, and payment accuracy.
6. Provide strategic leadership for value-based payment programs, including shared savings, capitation, pay-for-performance, and alternative payment models.
7. Oversee design, implementation, and ongoing optimization of VBP arrangements across key provider segments (e.g., primary care, large systems, specialists).
8. Partner with Medical Economics to develop financial models, performance benchmarks, and incentive methodologies.
9. Ensure alignment between contracting strategies and value-based program objectives.
10. Drive provider adoption and maturation along the value-based continuum through education, analytics, and performance reporting.
11. Establish performance measurement framework for provider quality, utilization, and total cost of care.
12. Oversee development of provider-facing dashboards and internal reporting to monitor VBP and network performance.
13. Leverage data analytics to inform provider engagement strategies and financial optimization opportunities.
14. Oversee implementation and monitoring of payment models, ensuring accurate configuration and performance tracking.
15. Evaluate financial performance of contracts and VBP programs, including impact on Medical Cost Ratio (MCR) and trend.
16. Support negotiation strategy by providing insights on provider performance and operational risks.
17. Ensure all provider servicing and VBP activities comply with federal, state, and accreditation requirements (e.g., CMS, Medicaid, NCQA).
18. Support regulatory reporting and audits related to provider network operations and value-based arrangements.
19. Maintain policies and procedures governing provider servicing and VBP operations.
20. Build and maintain strategic relationships with key provider organizations and executive stakeholders.
21. Lead Joint Operating Committees (JOCs) and provider governance forums.
22. Serve as a senior liaison between the health plan and provider community.
23. Drive continuous improvement in provider servicing workflows, tools, and technology platforms.
24. Partner with IT and analytics teams to enhance provider data, reporting, and automation capabilities.
25. Lead transformation initiatives linking provider servicing with population health and clinical operations.
26. Lead and develop high-performing teams across provider servicing and VBP functions.
27. Establish clear goals, KPIs, and accountability structures aligned with organizations priorities.
28. Foster a culture of collaboration, innovation, and continuous improvement.
Check for any duplicates: none.
Now Requirements paragraph: combine education/experience and understanding of reimbursement methodologies.
"Bachelor’s degree or 6 years of additional experience can be substituted in lieu of degree. A minimum of 10 years experience in provider relations, provider contracting, claims processing, correct coding, and customer service in a managed care organization including 5 years of progressive leadership experience. Strong understanding of reimbursement methodologies (FFS, capitation, shared savings, risk-based models)."
Now Skills list: items:
- Must possess strong communication skills and be comfortable with public speaking.
- Excellent financial and analytics as well as business acumen.
- Familiarity with the operations of sophisticated large integrated delivery systems, innovative business models, managing of a complex
for prose. We must not include any extra text outside HTML. Let's craft. First, About the role:
About the role
...summary...
Second, Responsibilities:Responsibilities
- ... each bullet ...
Requirements
... education/experience and understanding of reimbursement methodologies ...
Fourth, Skills:Skills
- ... each skill bullet ...
Benefits
- ... each benefit ...
Schedule
... work arrangement description ...
We must ensure we don't include headings with empty content. Now let's write the content precisely. About the role paragraph: combine the summary sentences. "The Director of Provider Network Servicing and Value-Based Payments is a senior leadership role responsible for the strategic oversight, performance, and integration of provider servicing operations and value-based payment (VBP) programs across all lines of business. This role ensures a high-performance provider network by driving operational excellence in provider engagement, issue resolution, and education, while advancing the transition to value-based care through effective program design, implementation, and performance management. The position partners closely with Provider Contracting, Medical Economics, Clinical Operations, and Finance to optimize total cost of care, improve quality outcomes, and strengthen provider relationships." Now Responsibilities list: we need to include each bullet as