Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!

We offer remote work opportunities (AK, AR, AZ, *CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)

Job Summary

Director will focus on expanding and strengthening our provider network through strategic recruitment of designated Corporate and National providers across all states for which TriWest is responsible to serve VA (CCN) and DHA (TRICARE). This role includes identifying, recruiting, and managing providers to include health systems, hospitals, ancillary providers, and other health delivery entities which cross one or more state boundaries. Negotiates and maintains all provider contracts including discounts, credentialing requirements, and provider data compliance. Supervises a team of contracting specialists. Ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives. Reports to the Vice President of Provide Network Development.

Education & Experience

Required:

• Bachelor's degree in Business, Health Care Administration, or equivalent experience
• 8+ years' experience in a managed care environment that includes provider contracting and negotiation experience within multiple states and/or territories
• 5+ years' management experience in the healthcare industry

Preferred:

• Experience in provider contracting for government programs and/or commercial lines of business
• Experience in management/supervision of provider contracting staff in a managed care environment
• Experience in utilizing a contract management system to manage contracting workflow
• Familiarity with Medicare payment and claims processing rules

Key Responsibilities

• Builds and maintains an adequate network of corporate and national providers that meet or exceed all required access standards.
• Directly recruits large healthcare systems and network affiliates to support the network requirements for VA and DoD contracts.
• Develops and maintains strong relationships with assigned providers.
• Develops negotiation strategies to achieve department performance objectives.
• Negotiates and secures contracts, including associated discounts, for all corporate and national provider entities.
• Coordinates credentialing and data compliance with Provider Network Management team.
• Monitors network to ensure adequacy is being achieved and institutes corrective actions to address shortfalls in network.
• Monitors and ensures resolution of routine and escalated provider issues.
• Communicates information regarding market needs, competition, and industry trends to management team.
• Provides training and development to team members.

• Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
• Maintains client confidence and ensures confidential information is protected.
• Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
• Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
• Provides development and training to Network Providers on changes and updates to TriWest processes and policies.
• Monitors productivity, quality and quantity of work performed by staff related to provider contracting.
• Demonstrates and maintains current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
• Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.

.:

• Collaborates closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes.
• Heads or participates in projects and committees assigned by Director or Vice President.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VAPC3), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel.

Working Conditions

Working Conditions:

• Availability to work non-regular hours as necessary
• Works within a hybrid environment
• Travel up to 20%
• Must be able to obtain appropriate security clearance

Company Overview

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!

Our job is to make sure that America's heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.

Benefits

We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Generous paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.