The Director, Provider Network Management Dallas, 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.
- Required - A Bachelor's Degree in business, healthcare, or related fields or equivalent work experience with directly related hospital and/or Provider Networking contracting experience
- Preferred - A Master's Degree in a related field
- Required - 7 years of experience in healthcare sector (preferably at an HMO or PPO)
- Required - 4 years of experience in managing and leading others
- Ability to lead/manage others in a matrixed environment
- Ability to influence internal and external constituents
- Strong background in provider contracts, provider demographic data and/or other data management processes and oversight
- Understanding of regulatory compliance management and reporting requirements for provider and network access information
- Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Ability to analyze information and covert related activities into a comprehensive work plan
- Ability to communicate and make recommendations to upper management
- Ability to drive multiple projects
- Ability to implement process improvements
- Ability to represent the company with external constituents
- Required - Intermediate proficiency working with Microsoft Word, Excel, PowerPoint and Outlook
- Preferred - Ability to lead and manage large technical projects with time sensistive complex reporting requirements.