Network Development Director(Preferred Experience In Contracting And Managed Care)

CareSource•Dayton, OH

2d•Hybrid

About The Position

Job Summary: The Network Development Director is responsible for hospital, provider and ancillary provider contracting, service, and provider data integrity to facilitate optimal member access, successful business growth initiatives and sound plan financial performance as it relates to unit pricing in select states, regions or markets. Essential Functions: Responsible for the development of networks in new markets Will have significant interactions with third parties, contractors, and various companies engaged to develop networks in new markets Responsible for provider recruitment of states, geographic regions, or markets as defined in the corporate strategic plans Develop a Contracting Strategy on an as needed basis for the various targeted markets Develop the key metrics to ensure a high level of network adequacy Responsible for robust competitor and provider competitive analysis and the creation of other information to formulate a business decision related to the provider network Compile quarterly and annual statistics Responsible for the effective integration of new providers into the Network Operations infrastructure Ensure that the provider setup for new markets or regions is consistent with the Departmental standards Provide oversight of provider contracting activities when completed by contractors or other individuals or entities working on behalf of the Health Plan Responsible for aggressive recruitment programs including recruitment materials and development and facilitation of quarterly reports Provide formal feedback, documentation, and resolution of areas for improvement and monitor sustained improvement Review audits of all performance from a productivity, performance, and quality perspective; address issues as identified Implement a process in conjunction with other departmental Directors to ensure an effective approach to on-boarding new providers Ensure the network complies with all regulatory requirements as well as with all company-mandated policies and procedures Ensure provider network is adequate, cost effective, competitive, stable and meets the corporate and regulatory access requirements Interact with the Finance Department in terms of pricing for provider contracts Chair or co-Chair operational committees that relate to the contracting process Participate in training sessions for providers and staff as appropriate. Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis Perform any other job duties as requested

Requirements

Bachelor’s degree or equivalent in health-related field
Minimum 5 years management experience required
Minimum of 3 years contract negotiation experience required
Intermediate computer skills
Proficient in Microsoft Word, Outlook, and Excel
Knowledge of Network Management Processes & Services
Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
Communication skills
Ability to work independently and within a team environment
Attention to detail
Familiarity of the healthcare field
Critical listening and thinking skills
Training/teaching skills
Strategic management skills
Proper grammar usage
Time management skills
Proper phone etiquette
Decision making/problem solving skills
Leadership experience and skills
Resiliency in a changing environment
Employment in this position is conditional pending successful clearance of a driver’s license record check.
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position.
CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment.
Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations.
CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position.
Request for accommodations will be completed through an interactive review process.
Mobile Worker: Will work at different office locations established by CareSource; will be required to travel approximately 35% of time to perform work duties; may be required to stand and/or sit for long periods of times
A valid driver’s license, car and insurance are necessary for work related travel
Required to travel to provider offices and will be exposed to weather conditions depending on geographic location

Nice To Haves

Master’s Degree or equivalent preferred
Managed care experience highly preferred

Responsibilities

Responsible for the development of networks in new markets
Will have significant interactions with third parties, contractors, and various companies engaged to develop networks in new markets
Responsible for provider recruitment of states, geographic regions, or markets as defined in the corporate strategic plans
Develop a Contracting Strategy on an as needed basis for the various targeted markets
Develop the key metrics to ensure a high level of network adequacy
Responsible for robust competitor and provider competitive analysis and the creation of other information to formulate a business decision related to the provider network
Compile quarterly and annual statistics
Responsible for the effective integration of new providers into the Network Operations infrastructure
Ensure that the provider setup for new markets or regions is consistent with the Departmental standards
Provide oversight of provider contracting activities when completed by contractors or other individuals or entities working on behalf of the Health Plan
Responsible for aggressive recruitment programs including recruitment materials and development and facilitation of quarterly reports
Provide formal feedback, documentation, and resolution of areas for improvement and monitor sustained improvement
Review audits of all performance from a productivity, performance, and quality perspective; address issues as identified
Implement a process in conjunction with other departmental Directors to ensure an effective approach to on-boarding new providers
Ensure the network complies with all regulatory requirements as well as with all company-mandated policies and procedures
Ensure provider network is adequate, cost effective, competitive, stable and meets the corporate and regulatory access requirements
Interact with the Finance Department in terms of pricing for provider contracts
Chair or co-Chair operational committees that relate to the contracting process
Participate in training sessions for providers and staff as appropriate.
Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis
Perform any other job duties as requested