Director, Network Management & Contracting

Hybrid Work Schedule

Position Summary-

Responsible for working in collaboration with the Chief Financial Officer, Vice President of Regional Operations and Vice President of Hospital Contracting to identify, develop and oversee opportunities for development and growth throughout all networks and service lines. Coordinates or performs projects/activities as delegated by Chief Financial Officer, Vice President of Regional Operations or Vice President of Hospital Contracting. The Director of Network Management, Ancillary and Institutional Contracting, is responsible for assessing network needs, monitoring operational and fiscal performance and contractual compliance by network; along with coordination of recruitment/ provider negotiation needs with Medical Management, Network Operations, Hospital Contracting and Provider Relations

Essential Duties And Resposibilities

• In collaboration with the Chief Financial Officer, Vice President of Regional Operations or Vice President of Hospital Contracting, identifies opportunities for the development and growth of Ancillary and Institutional Provider Networks; including but not limited to Hospital Contracting, Ambulatory Surgical Centers, Ambulance and Transportation Services, Dialysis Centers, Durable Medical Equipment, Home Health and Hospice Services, Imaging Centers, Laboratory and Pathology Providers, Physical Therapy, Occupational and Speech Therapy Services and Hospital-based Physician Groups.
• Identifies network needs and communicates deficiencies and/or new areas of growth to Chief Financial Officer, Vice President of Regional Operations, Medical Director(s) or Vice President of Hospital Contracting
• Coordinates recruitment and negotiation activities of Network Management staff assisting with Ancillary and Institutional contracting in assigned networks.
• Coordinates negotiation of Letters of Agreement for out-of-network providers as requested by Medical Management or Network Management.
• Assesses network performance and recommends changes to the network based upon financial or statistical results.
• Daily interaction with Medical Management and Network Management operational functions.
• Coordinates site audits for credentialing and Provider training purposes.
• Resolve Provider grievances and appeals in accordance with contractual requirements and corporate policy.
• Ensure contract compliance and adherence to DMHC, DHS, CMS and other regulatory agencies as required by contracting HMOs.
• Internal contract liaison for Claims, Customer Service and Utilization Management Departments.
• Develop and implement regional policies and procedures
• Facilitate quarterly Joint Operations Meetings with contracted Hospitals and Ancillary Providers as needed or requested.
• Conduct ongoing staff development activities that advance negotiation skills, provider relations and network development processes.
• Assure compliance with the Employee Handbook policies and procedures.
• Conduct staff meetings on at least a monthly basis.
• Maintain patient confidentiality so that HIPPAA compliance is always observed.
• Ongoing monitoring of staff assignments to ensure timely completion.
• Assist with special projects as assigned.
  
  

Education And Experience

• Must have at least 4-6 years supervisory experience in Contracting, Provider Relations or Physician Recruitment; more experience preferred
• Ability to work with all levels of management
• Advanced knowledge of contracting principles/tools and various managed care reimbursement methodologies
• Must have excellent verbal and written communication skills.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
• Must be able to travel within service area and have valid driver’s license and insurance