Director of Out of Network Solutions

JOB SUMMARY: This position is responsible for planning, directing, and coordinating all aspects of the department to ensure savings preservation and growth, service of all assigned business clients, and the effective communication of the Company's solutions to existing and prospective business partners. This job is responsible for providing the type of leadership, management, and vision necessary to achieve short and long-range business goals and to grow the business unit as well as ensuring operating efficiency. The Director is responsible for directing all facets of the department including staffing, goal setting, budget compliance, product evaluation and enhancement, and policies/procedures to ensure smooth and efficient operations. This job is also responsible for strategic planning and budget decisions.

 

JOB ROLES AND RESPONSIBILITIES:

 

1. Direct management of performance to ensure competent staff delivers quality results. This includes training, mentoring, motivating, and overseeing staff performance.
2. Develop, implement, and manage both short and long term goals, objectives, policies, and procedures based on current and future trends. Stay abreast of industry and/or customer changes and communicate as appropriate.
3. Compile, analyze, and report on trends to include performance improvement initiatives and exceptional client delivery.
4. Oversight and development of operational relationships and performance for both client and provider.
5. Review referral trends on a monthly basis referral trends to identify opportunities for performance improvement and operational efficiencies.
6. Manage departmental and team budgets including expenses, cost containment, and profitability.
7. Provide direction and guidance to other levels of management, through delivery of instructions and direction to staff on individual cases and the creation and distribution of goals and standards to subordinates regularly.
8. Act as a subject matter expert internally for the Team and other departments within the Company.
9. Select, develop, and evaluate staff to ensure the efficient operation of department.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate Company's Core Competencies and values held within.
13. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.

JOB SCOPE: The Director works independently and exercises significant discretion and independent judgment. The incumbent provides input to make critical business decisions, including staffing and process improvement, and impacts day-to-day operations through the oversight of claim resolution and providing direction to staff on individual cases. The incumbent manages and impacts overall department budgets as well as team profitability. The incumbent operates with considerable latitude for unreviewed decisions and uses an extensive range of knowledge to complete job responsibilities. The incumbent manages staff and helps provide thorough and appropriate responses to clients and providers to meet the goals of the department. This role has the authority to recommend and implement appropriate policies, procedures, and controls to assure compliance with applicable contractual provisions, regulations, and legislation. This position manages others and has the authority for all HR actions (hiring, firing, discipline, training, etc).