Manages physician contracting, network development and provider service functions for hospitals throughout Florida. Works in concert with medical management, sales, provider operations and provider service center personnel in developing actions to meet market growth and medical cost targets, and customer service excellence.
Reports to: VP, Field Network Management
Dept.: FL-Network Development-State
Location: Tampa, FL
- Develops a comprehensive network strategy to support market growth and medical cost targets.
- Negotiates and renegotiates contracts with hospitals.
- Establishes effective departmental practices and work closely with various departments (operations, regulatory, sales, etc.) to ensure contracts meet operating, financial and legal standards.
- Heavy emphasis on analyzing cost and utilization data to develop specific actions to manage medical cost trend.
- Ensures compliance with government programs such as Medicaid and Medicare for all contracting and network development purposes.
- Identifies areas to improve provider service levels within operating budget parameters.
- Creates and distribute provider and hospital communications ie: letters, newsletters, training materials, etc. to educate and enhance relationships within the provider community.
- Perform other duties as assigned.
- Bachelors level education or equivalent directly related experience; master's degree strongly preferred.
- At least 10 years of work experience in the healthcare sector (preferably at HMO or PPO).
- 7 years experience in HMO provider/hospital/ancillary contracting and network development.
- Knowledge of regulatory requirements concerning Medicare and Medicaid.
Communication and Numeric Skills:
- Oral and written communication skills sufficient to communicate clearly and grammatically both complex and simple messages to a wide audience either within or outside of the organization.
- Superior negotiating and customer service skills.
- Excellent analytical skills including ability to identify unusual variation in medical costs and to assess impact of change.
- Knowledge of email systems such a Microsoft Outlook sufficient to communicate with both internal and external contacts.
- Strong aptitude with use of PC applications including spreadsheet, database, word processing and Microsoft Access.