[Hiring] Director Provider Network and Operations @Community Health Options

Role Description

The Director, Provider & Network Operations is responsible for providing guidance and oversight over network management including:

• Provider Relations
• Provider Contracting
• Credentialing
• Provider Data Integrity

The Director will exhibit insight, innovation, and leadership to drive multiple strategies while continuously improving quality, financial viability, access, and provider satisfaction. The position will assist in developing, leading, aligning, and implementing the execution of tactical initiatives and strategies. In partnership with the Senior Vice President, CFO, and Senior Leadership, the Director will integrate provider network plans, activities, and policies throughout the department to meet company objectives.

The position is responsible for monitoring all aspects of the network, provider performance, and trends to ensure networks are developed and suitable to meet business needs. The Director will serve as a liaison between the organization, hospital leaders, and physicians to develop, communicate, and execute strategic direction for the network. This position will also be directly involved in contracting discussions with larger and more complex partner arrangements.

Qualifications

• Bachelor's degree is required; master's degree desirable
• Minimum 5 years of management experience
• A minimum of 5 years of experience in provider contracting and provider relations
• Must understand Medicare, RBRVS, case rate, capitation, and other related payment structures

Requirements

• Responsible for assuring the financial viability, overall service, and quality and performance of provider networks
• Oversees the development and implementation of provider contracting strategies and negotiations
• Leads provider contracting and servicing activities for business expansion
• Develops and implements strategies to strengthen and/or develop new physician, hospital, and other provider relations
• Defines provider network expansion requirements in new and existing geographic service areas
• Approves and monitors special requests, retroactive adjustments, reimbursement, and contract exceptions
• Modifies networks, contracts, reimbursements, credentialing standards, and utilization trends as needed
• Collaborates with physicians and other organizations to develop mutually beneficial business opportunities
• Maintains access to a high-quality, geographically desirable, cost-effective network of specialists, hospitals, and ancillary providers
• Directs the implementation of new health plan contracts/product lines
• Directs rate analysis, scope assessment, and geographic coverage assessment
• Oversees all primary IPA, Medical Group, and Hospital market research
• Oversees initiatives to engage with local or regional Accountable Care Organizations (ACOs)
• Monitors industry changes, trends, and events to identify opportunities for market penetration and performance improvement
• Oversees recruitment of providers for new networks
• Ensures network providers meet quality, cost, and coverage standards
• Develops and manages team and corresponding budget
• Provides strategic direction to lead network development
• Assists with provider relations activities as needed
• Collaborates with internal teams to align network strategy with clinical and financial objectives
• Updates and interfaces with senior leadership team on initiatives
• Oversees the determination and implementation of any health plan or regulatory corrective action plans

Benefits

• Superior customer service support is essential
• Excellent organizational and time management skills

Diversity, Equity, and Inclusion Statement

Community Health Options is committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion (DEI). Our human capital is the single most valuable asset we have. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self-expression, unique capabilities, and talent our employees invest in their work represents a significant part of not only our culture, but our reputation and achievement as well.

Community Health Options DEI initiatives are applicable, but not limited to, our practices and policies on recruitment and selection; compensation and benefits; professional development, and training; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of DEI, which encourages and enforces:

• Respectful, open communication and cooperation between all employees
• Teamwork and participation, encouraging the representation of all groups and employee perspectives
• Balanced approach to work culture through flexible schedules
• Employer and employee contributions to the communities we serve