Strategizes the execution of physician contracting, network development and provider service for hospitals in large, complex markets. Works to ensure partnership with medical management, sales, provider operations and provider service center personnel in developing actions to meet market growth, medical cost targets, and customer service excellence.
Reports to: COO, State FL
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 and implements effective departmental practices and works closely with various departments (operations, regulatory, sales, etc.) to ensure contracts meet operating, financial and legal standards.
- Analyzes 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 and implements areas to improve provider service levels within operating budget parameters.
- Oversees the creation and distribution of provider and hospital communications ie: letters, newsletters, training materials, etc. to educate and enhance relationships within the provider community.
- Perform other duties as assigned.
- Ability to travel by automobile, plane or other public transportation as necessary.
- Required A Bachelor's Degree in a related field
- Required or equivalent work experience
- Preferred A Master's Degree in a related field
- Required 12 years of experience in the healthcare sector (preferably at HMO or PPO)
- Required 8 years of experience in HMO provider/hospital/ancillary contracting and network development
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated written communication skills
- Advanced Demonstrated customer service skills
- Advanced Demonstrated analytical skills
- Intermediate Ability to multi-task
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Demonstrated organizational skills
- Advanced Demonstrated negotiation skills Negotiating skills
- Intermediate Other Knowledge of regulatory requirements concerning Medicare and Medicaid
- Intermediate Other Ability to identify unusual variation in medical costs and to assess impact of change
- Intermediate Other Ability to remain calm under pressure
- Required Intermediate Microsoft Outlook
- Required Advanced Microsoft Access
- Required Advanced Other PC applications including spreadsheet, database, word processing