The Director, Provider Network Operations Louisiana, will direct a team in managing physician contracting, network development, provider relations and provider operations. Develops, executes and maintains a provider network strategy. Works in concert with medical management and sales to develop strategies to meet market growth and medical cost targets. Provides service and education to network physicians/providers.
Key Duties and Responsibilities:
- Leads a team of department managers in developing and executing strategic departmental initiatives.
- Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting as well as risk contract management.
- Manages required Hospital Contracting as appropriate.
- Monitors primary care and specialty risk arrangements for Medicaid, and Medicare product lines.
- Performs data analysis and develops specific actions to manage medical cost trend.
- Develops best practice to assist risk partners in managing financial risk.
- Identifies areas to improve Provider service levels.
- Educates/enhances relationships within the provider community.
- Manages Provider Network integrity and compliance.
- Manages claims projects as necessary/required.
- Manages provider loads as necessary/required.
- Special projects as assigned or directed.
- A Bachelor's Degree in Business, Healthcare or related field is required or equivalent work experience with directly related hospital and/or Provider Network contracting experience beyond the 5-7 years required
- Master's Degree in a related field is preferred
- 7 years of experience in healthcare sector (preferably at HMO or PPO) is required
- 5 years of experience in HMO provider/hospital/ancillary contracting and network development is required
- 4 years of management experience is required
- Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum.