Director, Provider Relations and Contracting - Total Care

(Full Time FTE 100%) Mon. - Fri. 8:30am - 5:15pm

Responsible for maintaining the existing, as well as developing new, MCO provider service delivery networks for a multi product multi county MCO. This includes contracting with new providers in expansion service areas and maintaining an appropriate network in current service area. Responsible for analyzing requirements of the regulatory agencies and determining actions needed to maintain network approval. Maintains and submits all provider network reports to regulatory agencies. Maintains and publishes provider directory and addenda on a schedule and ensures directory and addenda are in compliance with regulatory requirements. Ensures provider contracts meet regulatory requirements and submits changes and/or new contracts to NYSDOH for approval. Maintains appropriate staff to provide excellent service to the provider network. Requires knowledge of managed care principles, operations and regulations preferably as they relate to the operation of the New York State Medicaid Managed Care program and the Child Health Plus and Family Health Plus programs. Knowledge of New York State MCO regulations and reporting requirements. Ability to analyze provider network composition versus available benchmark data and/or regulatory requirements. Ability to work with regulatory agency personnel, outside consultants, and service network providers in order to enhance the compliance and operational performance of the MCO.

Knowledge of PC networks, mainframe databases, and other IS tools required. Bachelor Degree. Master’s preferred. Minimum years in Health Care contracting, sales or Health Insurance required. Minimum 5 years supervision/management.

Please contact careers@schcny.com for application or more information.

SCHC Companies, Inc. considers all applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status. We will afford reasonable accommodation to qualified applicants and employees with a known disability that does not cause any undue hardship. When filling a vacancy, SCHC Companies, Inc. will, whenever possible, promote or transfer a qualified employee before considering outside candidates.