Director, Network Management

Overview

Now is the time to join us! 

 

We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities

Who are you?

 

The Director, Network Management is a key role responsible for overseeing network strategy, development, and management across our Health Plan Administration organization. This position involves driving network expansion, new network strategy, optimizing payer, provider and health system relationships and ensuring compliance with regulatory standards. The Director will collaborate closely with key stakeholders to enhance partnerships, maintain cost-effective network solutions and ensure the highest quality of service to our members.

 

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Strategic Network Development

  • Support development and execution of strategic initiatives to expand and optimize existing networks, focusing on growth, access, and quality.

  • Analyze market trends and regulatory changes to adjust network strategies and meet organizational objectives.

     

• Network Relationship Management

  • Manage business relationships with Payer and Health System partners to support goals including membership growth, retention, margin and quality.

  • Negotiate and maintain contracts in partnership with legal, focusing on cost management, quality and compliance.

  • Network Performance and Compliance

• Develop and oversee network performance metrics.

  • Identify opportunities for stronger partnerships and collaborate with sales on RFPs/RFIs.

  • Build network reporting package and heat map to inform growth and expansion opportunities.

  • Partner with compliance and legal teams to ensure compliance with all relevant regulatory and accreditation standards.

  • Oversees network administrative functions including but not limited to: the provider portal system, policies and procedures, RFPs, network disputes and settlements, and network regulatory activities.

• Cross Functional Collaboration

  • Collaborate with finance, sales, product, and medical management teams to align network strategy with organizational priorities.

  • Work together with sales to develop network expansion, network and partnership strategies by region.

  • Support business development efforts by providing network insights, reporting and analysis for prospective opportunities.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Qualifications

What you bring to the Personify Health team:

 

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• Bachelor’s degree in Business Administration, or a related field OR equivalent experience; a master’s degree is a plus

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• 7+ years proven experience in network management within a carrier or TPA space with a strong understanding of contract pricing and its impact on P&L.
• Experience in self-funded administration.
• Excellent communication skills with the ability to convey complex information clearly and effectively to various stakeholders.
• History of cultivating and managing external stakeholders.
• Strong presentation skills, analytical and problem-solving skills, with a keen attention to detail.
• Strategic thinker with the ability to participate in and contribute to high-level planning discussions.
• Ability to work independently and collaboratively in a fast-paced and matrixed environment.
• Advanced organizational skills with ability to handle multiple assignments/projects at once.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about