Director, Provider Relations and Medical Networks

The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process.

Encova Insurance is seeking a Director of Provider Relations and Medical Networks. This can be a home-based role open to candidates residing anywhere within our payroll footprint, as detailed on our careers page. Occasional travel may be required for meetings or projects. The position will report directly to the Vice President of Claims Product and Operations.

Are you a Referral?

If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team.

Unique residence requirements are listed in each job posting, please review closely for details.

Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes:

Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.

JOB OBJECTIVE:

The Director, Provider Relations and Medical Networks leads a technical team and is responsible for developing and executing strategies to manage and reduce medical expenses within the workers' compensation program. This role ensures compliance with regulatory requirements, oversees vendor relationships, and implements best practices to deliver quality care while controlling costs.

ESSENTIAL FUNCTIONS:

• Provide leadership through coaching, mentoring and directing the medical network, provider relations and medical bill review teams providing them with development opportunities as appropriate.
• Develop and implement medical cost containment strategies aligned with organizational goals.
• Monitor industry trends and regulatory changes to ensure compliance and optimize performance.
• Manage provider networks, utilization review, bill review, and pharmacy benefit programs.
• Oversee negotiations with medical providers and vendors to ensure competitive pricing and quality outcomes.
• Analyze medical cost drivers and identify opportunities for savings.
• Prepare reports and present findings to senior leadership with actionable recommendations.
• Work closely with claims teams, nurse case managers, and legal to ensure integrated cost containment efforts.
• Serve as a subject matter expert for medical cost containment strategies and regulatory compliance.

OTHER FUNCTIONS:

• Other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Bachelor's degree or equivalent in healthcare administration, business, or related field is required.
• Minimum of 7 years of insurance experience in workers' compensation or medical cost containment is required.
• Strong knowledge of provider networks, fee schedules, utilization review, and pharmacy management.
• Excellent communication, negotiation, analytical, and leadership skills. Previous experience in a leadership or management role is strongly desired.
• Demonstrated experience with managed care programs and vendor management is preferred.
• Familiarity with state workers' compensation regulations and cost strategies is strongly preferred.
• Ability to lead cross-functional teams and drive measurable results.

This position has been evaluatedin accordance withthe Americans with Disabilities Act. Encova Insurance makes every effort toreasonably accommodatedisabilities topermitperformance of the essentialfunctionsand candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties,responsibilitiesand qualificationsrequired. It providesan accurateoverview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.

Ready to join our team?
At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating, and financially rewarding opportunities. Join us to discover a work experience where you can learn and grow to your fullest potential.

What you can expect from us

In addition to a competitive compensation package, we offer a comprehensive benefits package designed to support the well-being and growth of our associates. Available benefits (subject to any policy or plan changes) include, but are not limited to:

• Health, Dental & Vision Insurance

• Company-provided life and income protection plans

• Eligibility to participate in a company incentive bonus program

• 401(k) Retirement Plan - 100% company match up to 7% on annual salary

• Paid Time Off, Paid Holidays, and Floating Holidays

• Flexible Work Arrangements - Hybrid and remote depending on the role

We believe that happy, healthy associates are the foundation of great work. Join us and thrive both professionally and personally.

Encova Insurance is an EOE/E-Verify employer.