Manager, PPO Provider Network Contracting

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Manager, PPO Provider Network Contracting

POSITION OVERVIEW:  

Manages the daily operations of the medical network development/PPO contracting team. Develop and lead a team of PPO contractors to recruit and maintain providers in certified and non-certified states. Ensures that Careworks meets the access standards required in the medical PPO and certified networks through providing focus and oversight of the provider network development team.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Contracts and leads negotiation/renegotiation activity with major hospitals and VIP provider groups.
• Develops solid relationships with major providers in the network and recruit’s new large provider groups.
• Determines quotas for team members through effective management of leads and access requirements.  Assign contracts to team members ensuring goals include quantity and quality requirements.
• Ensures team members meet and/or exceed quotas by supporting in their day-to-day activities to reach goals, including access to the appropriate tools and information, and providing feedback and business knowledge to be successful.
• Trains new colleagues, develop existing colleagues, identify gaps in processes, and identify training opportunities.
• Communicates and presents network developing details to upper-level leaders and other parties, including internal and external clients.
• Resolves escalations while identifying any systemic issues that can be resolved through process improvement and/or training opportunities.

SUPERVISORY RESPONSIBILITIES

• Provides support, guidance, leadership and motivation to promote maximum performance.
• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
• Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Travels as required.

QUALIFICATIONS

Education & Licensing
Bachelor's degree in business or health care administration from an accredited college or university preferred.

Experience

Five (5) years of related experience or equivalent combination of education and experience required. Experience in managing complex contract language and negotiations. Familiarity with bill review operations and practices and working with compensation providers preferred.

Skills & Knowledge

• Excellent oral and written communication skills, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Proven management/leadership skills
• Excellent negotiating skills
• Ability to create and complete comprehensive, accurate and constructive written reports
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

• Mental:  Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
• Physical:  Computer keyboarding, travel as required
• Auditory/Visual:  Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.  They are not intended to constitute a comprehensi