Director Network Management

Regal Medical Group•Los Angeles, CA

7d•$95,000 - $100,000

About The Position

The Director of Network Management is responsible for network growth and development, physician recruitment and contract negotiations. The Director will manage a team of Network Managers, monitor operational and fiscal performance, membership growth, contractual compliance, marketing, business development, provider contracting, provider relations and provider education. The Director is also responsible for working in collaboration with the Senior Vice President of Regional Operations & the Vice President of Network Management to identify, develop and oversee opportunities for growth within a specified region/campus. In addition, this individual coordinates or performs special projects/activities as delegated by the Senior Vice President of Regional Operations. The individual in this position will also be a strategic leader for aligning business development opportunities with the organization’s goals & mission.

Requirements

Must have at least 4-6 years supervisory experience in provider relations & physician recruitment
Minimum 3-5 years of experience in negotiating professional and ancillary provider contracts or equivalent experience to support negotiations
Effective oral, written and presentation skills
Advanced knowledge of contracting principles/tools and various managed care reimbursement methodologies for Medicare, Medi-Cal and Commercial programs/products
Effective oral, written and presentation skills
Effective interpersonal skills
Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)

Nice To Haves

Financial and analytical skills a plus
Bachelor’s Degree preferred or equivalent experience

Responsibilities

Responsible for working collaboratively with the Senior Vice President of Regional Operations, the Vice President of Network Management and Medical Management team to ensure network growth and development initiatives are being met and networks are operating within budget.
Responsible for the oversight of negotiations of provider contractual agreements by network managers during Primary Care, Specialty and Ancillary recruitment projects.
Serves in a leadership capacity in strategic initiatives, special projects, business development or network planning.
Coordinates or performs special projects/activities as delegated by Senior Vice President of Regional Operations & Vice President of Network Management
Assists with identification of potential providers within targeted area and ensure non-participating providers who are essential to the network are recruited.
Responsible for the oversight of Network Managers for assigned campus/region
Responsible for the oversight of assigned network(s) to ensure network provider deficiencies are being resolved.
Works closely with assigned Network Support staff and Medical Management counterparts to ensure network needs/changes are being effectively addressed and communicated both internally and externally.
Work closely with Regional Medical Directors & other leaders within organization.
Assist with the resolution of provider grievances and appeals in accordance with contractual requirements; Health Plan requirements, and corporate policy.
Assist with the resolution of claims issues by working with appropriate internal departments.
Ensure contract compliance and adherence to DMHC, DHCS, CMS and other regulatory requirements.
Ensure accurate and timely data reporting requirements are being met including eligibility and capitation reports, risk sharing, risk pools, claims timeliness, pharmacy utilization, bed days utilization, encounter data and audit compliance agencies as required by company policy and contracting HMOs.
Perform on-site visits (as required) to physicians, physician groups, hospitals and ancillary providers.
Facilitate the quarterly Joint Operations Meetings and Town Halls with contracted providers and office staff.
Follow and adhere to Employee policies and procedures.
Maintain patient confidentiality and ensure HIPPAA compliance is observed at all times.
All other duties as directed by management.
Some evening hours required for facilitation of physician events such as Town Halls or Physician meetings.