Director, Network Contracting - SHCN
The Director of Network Contracting reports to VP of Network Services. Responsibilities: Provide strategic direction for and oversight of all network development activities. Oversees negotiation of all provider and payor contracting activities. Coordinates with other departments to ensure timely response to provider concerns and manage the relationships throughout the provider and payor community for all lines of business. Works with Medical Economics to monitor and maintain network adequacy and accessibility, market parity and relative deal strength. Oversees the development of provider contracts to ensure compliance with state and federal requirements. Oversees the maintenance of policies and procedures related to provider recruitment and contracting. Establishes a provider recruitment plan for new business opportunities. Participates in responses to RFPs, specific to provider network services development. Monitors recruitment to ensure compliance with contractual network adequacy standards. Coordinates with other departments to ensure the provider network meets the health care needs of all plan members. Responsible for departmental staffing decisions and provides supervision to assigned network personnel.
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment ΓÇô while still being valued for your individual strengths ΓÇô Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
- Master's degree in healthcare administration or commensurate managed healthcare experience.
- Experience in leading Provider Relations and Network Development personnel required
- At least three (3) years experience working in Medicaid, Medicare, and Commercial contracting desired
- Knowledge of messenger model
- Knowledge of gain sharing
- Knowledge of provider contracting
- Computer experience necessary
- Effective time management skills
- Effective interpersonal and communication skills
- Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames
- Ability to manage large workload
- Make independent decisions
- Ability to maintain positive work relationships
- Ability to supervise and lead others
- Ability to maintain a positive work environment for employees
- Work cooperatively, positively, and collaboratively in an interdisciplinary team