Network Development Director(Managed Care Experience Preferred)

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

Education and Experience:

• Bachelor’s degree or equivalent in health-related field
• Master’s Degree or equivalent preferred
• Minimum 5 years management experience required
• Minimum of 3 years contract negotiation experience required
• Managed care experience highly preferred

Competencies, Knowledge and Skills:

• 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

Licensure and Certification:

• Employment in this position is conditional pending successful clearance of a driver’s license record check.  If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in this position, employment in this position will be terminated
• 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