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Job Summary

This position is responsible for developing and implementing the methodology which results in competitive contract pricing while maintaining a broad network of hospitals, physicians, behavioral health and ancillary providers primarily in the Montana market but also including activities in Oklahoma and New Mexico. Directing and overseeing management and staff responsible for contracting, provider relations activities, network directories, provider/facility database and reporting. This position collaborates with HCSC Network Management colleagues in the development of Enterprise Network strategies and initiatives.

Job Responsibilities:
1. Direct and manage a staff of management, professional and support personnel responsible for contracting, data base and reporting who are engaged in the recruiting, contracting, educating and maintenance of a cost effective statewide network of facilities and providers. Plan, organize and coordinate the implementation of programs and activities designed to sustain and improve our working relationship with facilities/providers and to enhance HCSC’s image in the community.
2. Assist in the development of facility and provider strategies, direct the implementation of strategies and initiatives, and ensure attainment of goals.
3. Oversee maintenance of broad statewide managed care networks.
4. Directly handle or “close” contracts on special or large contracts. Maintain direct strong working relationships with key providers, groups and community leaders. This is critical because this position is directly involved in the most difficult and large key facility/provider negotiations.
5. Develop plans and recommend the solutions for dealing with issues with significant impact on the business to Senior Leadership. Ensure communication to Sales and Actuarial of the impact of the changes in the network or the impact of projected fee schedules.
6. Work closely with Sales and the Data Analysis and Reporting team to assess the competitive position of the networks. This includes evaluating both the accessibility of providers and the discount levels in order to ensure the network meets our customer’s needs. Analyze provider satisfaction survey results and formulate resolutions for problem trends which will aid in the maintenance of existing groups and the acquisition of new groups.
7. Maintain and further develop cooperative working relationship with other HCSC areas such as SSD, ITG, Credentialing and EHCM to ensure successful coordination of provider related activities within established timeframes. Promotes and facilitates expanding the use of existing technology to enhance the efficiency and effectiveness of business conducted between BCBS - Plan Division and facilities/providers.
8. Responsible for leadership of the facility and provider network groups. People management responsibilities include but are not limited to performance management, pay administration, professional development, diversity, change management, and development and maintenance of budget.
9. Develop and monitor an effective communication/training program to keep contracting representatives apprised of new/additional servicing responsibilities in conjunction with other members of division management. Oversee provider/facility education and servicing including orientations, service calls and the production of education materials, and training of internal staff and other internal departments.
10. Responsible for Quality Improvement Programs to ensure all facility/provider agreements, policies and processes comply with state regulations, corporate standards, legislative mandates and accreditation/federal guidelines.
11. Oversees the development and production of communication materials for facilities/providers and facility/provider directories.
12. Participate with financial strategy committee in the assessment of network results as related to cost and utilization.
13. Responsible for department responding to facility/provider inquiries in an effective and timely manner and work with other departments/teams to resolve claims processing and claims payment problems.
14. Analyze monthly activity reports, budget and variance reports and formulate resolutions for problem trends.
15. Responsible for meeting with largest accounts periodically to hear their perspectives, respond to their issues and to exchange ideas concerning the provider network. This also includes communicating with the lar