The Senior Director, Network Management, is accountable for the development, growth, and performance of their assigned geography and/or health delivery networks. Working closely with the regional executive teams, the Sr. Director will lead the market's clinical performance activity related to growth, CAHPS, MRA and STARS measures and produce outcomes consistent with corporate guidelines and requirements. The Senior Director, of Network Management will offer technical leadership and expertise to both regional and corporate initiatives for physician, hospital, and ancillary contracted networks. Which shall include direct communication to improve quality performance goals with IPA and Hospitals. Oversee, as assigned Regional Performance of Network.
General Duties/Responsibilities (May include but are not limited to):
Develop and execute strategies for optimal network and network development in established and new markets.
Leverages the competitive landscape to assess and design network and contracting strategies.
Works with multidisciplinary team to produce desired growth, financial, and operational outcomes.
Collaborate with the regional executive team and other departments to ensure contracted network support of operating goals, including STARS, HEDIS, MRA, and other initiatives.
Works closely with Regional Medical Officer and collaborates with other departments to ensure overall success of the market. Meets and exceeds budget and operating goals.
Identify and contracts with new PCPs and specialists to develop the network.
Analyzes current and projected network needs from cost/utilization and competitor standpoints.
Partners with Contracting to analyze and negotiate contract rate and language proposals.
Develop strong relationships with key external stakeholders, physician leaders, network physicians, hospitals, and ancillary providers.
Partners with Sales and Member Experience teams to develop and execute growth and retention plans.
Lead and manage IPA market management resources to ensure execution of operating, performance, and growth initiatives.
Lead and manage Provider Service Representatives to maximize engagement through consistent face-to-face interactions, in-service visits, training sessions, and outcome reviews.
Weekly status update to Regional VP - Track and report network performance and opportunities for assigned regions.
Contributes expertise to development of organizational best practices.
Supervisory Responsibilities:
Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees. Will also oversee third-party vendors and/or student workers as appropriate.
Minimum Requirements:
12-15 years of experience in managed care or health care field, including a strong understanding of reimbursement methodologies, contract language, negotiation strategies, financial modeling and analysis, managed care and Medicare Advantage plans; or any combination of education and experience, which would provide an equivalent background.
Experience with delegated and non-delegated providers
Education/Licensure:
Requires a BA/BS; MBA preferred.
Other:
Must have strong analytical skills and customer service skills.
Excellent knowledge of hospitals and managed care finance and contracts
Strong knowledge of Medicare managed care and associated contract language
Excellent interpersonal and relationship management skills
Excellent oral, written and presentation skills
Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposal.
Excellent Microsoft Office skills, including Word and Excel
Ability to travel by car or air
Available for evenings/weekends and extended work hours as needed
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
