Job/Position Summary:
Responsible for operating and overseeing the day-to-day operations of the Specialty Provider Networks which the respective individual manages for Health Network One (HN1).
Essential Functions & Responsibilities:
- Supervise the identification and qualification of all Health Care Providers eligible to participate in the Specialty Provider Networks (SPN) that are assigned to the respective individual.
- Develop, establish and/administer the goals and objectives set for the assigned Specialty Provider Network(s).
- Direct, guide and support the activities of any Network Development staff that support these Specialty Provider Networks.
- Advise senior management of both strengths and weaknesses in the SPN and institute or recommend changes which better serve the organization and its assigned membership.
- Direct and supervise the recruitment and negotiation of contracts with Providers.
- Direct and supervise the development of understanding in the staff of all SPN contract document protocol(s).
- Act as a liaison between HN1 and Providers with all relevant matters concerning contractual and financial terms as stated in Providers’ contract with HN1.
- Act as a senior liaison between HN1 and Health Plans with all relevant matters concerning contractual, financial and operational terms as stated in HN1’s network agreements with Health Plans.
- Develop and recommend health care scopes of services and financial parameters to senior management for contracts between HN1 and Providers and Health Plans.
- Direct and supervise the coordination of the expansion, renewal or relocation process for Specialty Provider Offices.
- Develop and maintain familiarity with the managed care industry, such as availability of
- outside sources of information, statutes affecting HN1 business, current industry trends, and general services/locations of major non-contracted providers.
- Attend all staff and committee meetings as requested by the Vice President of Network Operations and/or President & COO.
- Must support company philosophies, objectives, decisions and policies.
- Ensure adherence to department and organizational standards, policies and procedures, including HIPAA
- Ensure integrity of data entered into Company systems and/or databases
- Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
- Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
- Ability to come to work and work the regular schedule and shift for the position.
- Compliance with all personnel policies and procedures.
- Perform additional duties and related essential duties as assigned.
Required Education and Experience:
- Bachelor's degree (B. A.) or five (5) plus years senior management contracting/development experience.
- Two or three years extensive working background in the managed care industry.
Certificates, Licenses, Registrations:
- Valid State Drivers License, required.
Supervisory Responsibilities:
- Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Other Skills and Abilities:
- Full working knowledge of operations, benefits and systems of HN1 and Health Insurance industry.
- Excellent analytical and problem solving skills.
- Strong interpersonal and verbal and written communication skills.
- Ability to conduct meetings and presentations to health care providers and internal personnel.
- Knowledge of local medical community.
- Knowledge of medical terminology, CPT coding, and billing procedures.
- Strong contracting background.
Working Conditions: Normal office environment.
Job Type: Full-time
Pay: From $100,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Schedule:
Language:
- English/Spanish (Preferred)
Willingness to travel:
Work Location: In person