Network Management Sr. Manager (Must reside in Washoe or Clark County, NV)

The Network Management Sr. Manager is responsible for contracting with all provider types and successful provider network performance related to key financial, operational, and member satisfaction performance indicators in a multi-market territory. Works closely with Network Management and other departments to enhance the contracted provider experience consistent with company’s mission statement and values.

General Duties/Responsibilities (May include but are not limited to):

• Collaborate with Network Management leadership in the development and execution of the contracting strategy.
• Recruit providers to eliminate network deficiencies within a specific region.
• Negotiate / re-negotiate and finalize all contracts which may be primary care, specialist, ancillary, hospital, group/IPA as well as ensure the accuracy of administration of these agreements.
• Assure the day-to-day operations of the provider network are consistent with standards/ expectations and develops provider education materials as needed to support adherence with company requirements.
• Develop agendas and lead Joint Operations Meetings to drive results, including oversight of New Provider Orientations and new Contract Orientations.  Meetings will focus on addressing performance improvement metrics, resolving operational issues, including but not limited to utilization management, financial, enrollment, member appeals and grievances, provider termination/panel closures, continuity of care, and marketing activities.
• Responsible for the execution of regional work-plans, monitoring performance metrics, updating status, and communicating progress both internally and externally to ensure results.
• Responsible for timely and professional interaction with internal and external customers.
• Ensure accurate and timely data reporting requirements are being met for designated regions, including but not limited to provider network contacts, eligibility and capitation reports, risk sharing, claims timeliness, pharmacy utilization, bed day utilization, encounter data and audit compliance.
• Develop goals and objectives that align with Network Management leadership’s  performance metrics to ensure department KPIs are met, as well as the organization’s vision for future growth and network development.
• Utilize contracting knowledge for effective problem resolution and compliance.  Responsible for timely and professional interaction in response to grievances.  Research, analyze and resolve complex problems dealing with hospital shared risk pool, claims, appeals, and eligibility issues within the appropriate limits.
• Create and implement policies and procedures for the department. Interpret company policies and procedures. 
• Represents the department in interdepartmental meetings and selected committees.
• Other projects and responsibilities as assigned

Minimum Requirements:

• Minimum 5-7 years’ experience with an HMO, managed care provider organization (IPA, Medical Group or institutional provider) or insurance company with at least 3 years’ specific experience in managed care contracting and knowledge or Medicare Advantage regulatory guidelines.
• Proficient in MS Office, including strong Word and Excel proficiency.
• Bachelor’s Degree or equivalent experience required
• Detail oriented.
• Language Skills:  Ability to read and interpret documents such as contracts, safety rules, operating and maintenance instructions and procedure manuals.  Ability to interpret government regulations a must.  Ability to write routine reports and correspondence. 
• Ability to speak effectively before groups of providers or employees of internal/external organization.
• Mathematical Skills:  Ability to calculate figures and amounts such as fee schedules, per diem rates, discounts, interest, commissions, proportions, and percentages.  Ability to apply concepts of algebra, geometry and statistics.
• Reasoning Skills:  Strong analytic and problem-solving skills required, including ability to synthesize, interpret and apply detailed and complex information.
• Office Hours:  Monday-Friday, 8am to 5pm.  Extended work hours, as needed.
• Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.
• Drives approximately 20-40% of the time to provider sites. 

Pay Range: $90,000 - $120,000 annually.