Returning Candidate?

Director - Provider Network Management

Director - Provider Network Management

Job ID 
2017-4398
Job Locations 
US-CT-Hartford
Category 
Provider/Network Management

More information about this job

Overview

Network Management Directors are responsible for the vision and outcomes driven by their assigned team, geography, and plan. The team drives all aspects of provider network management for an assigned geographic area, typically comprised of various states. Not the typical Network Management role, Network Management Directors function like P&L leaders as they have direct responsibility over Gross Margin which impacts CCX’s profitability (and resulting EBITDA). Responsible for the successful alignment of CareCentrix with market capabilities and needs for innovation, focused on our CareCentrix Providers.

Responsibilities

• Responsible for Network Adequacy across all team assigned geographies
• Responsible for financial performance of network across all team assigned geographies and plans
• Responsible for network QUALITY and management of team monitoring and enforcing contract terms, administering corrective action plans and coordinating audit activities.
• Acts as subject matter expert for contract templates, and regulations surrounding network administration and claims payments.
• Responsible for the network contracting strategy, new business, and new product implementation for their team assigned geography
• Acts as a subject matter expert in response to Client, Provider, and internal requests
• Identify pressing market factors, factoring in current and future needs.
• Create agile, network infrastructure capabilities to ensure CareCentrix is the clear market leader.
• Develop a strategically defined provider network as needed for new products with accompanying goals and objectives.
• People Management Accountable for the development, mentoring and morale of direct reports/ Network Team
• Drive provider strategy and development with an emphasis on competitive intelligence, market trend analysis and market research.
• Ensure requirements are accurately identified within and across strategies and that regulatory, administrative and marketing documentation are is readily producible.
• Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
• Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.

Qualifications

• Bachelor’s Degree and/or 7+ years’ experience in Provider, Network, Contract, or Relationship Management in a transferrable discipline required. Master’s Degree preferred
• Demonstrated work experience in execution of strategic planning
• Excellent organizational and analytical skills required. Knowledge of Utilization Management and URAC standards preferred
• Proven Track record of increased sales productivity through identification and implementation of strategic business plans
• Demonstrated ability to lead and direct cross functional team
• Proven ability to establish priorities and achieve results
• In depth knowledge of managed care
• Advanced proficiency in Microsoft Excel, PowerPoint, Visio and Access
• Demonstrated ability to lead projects, demonstrate outstanding interpersonal skills and work well with people and foster and facilitate collaboration with internal stakeholders
• Ability to think strategically and translate into deliverable results
• In depth knowledge of managed care and specialty managed care
• Problem solving abilities
• Strategic thinker
• Negotiation skills
• Financial acumen

 

CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.