Manages physician contracting and network development for an assigned region. Responsible for developing, executing and maintaining a provider network strategy. Continuously evaluates network to ensure cost effective, optimal functionality. Works in concert with medical management and sales developing actions to meet market growth and medical cost targets.
- Leads a team of Network Management Representatives and/or Specialists in developing, servicing and contracting providers.
- Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management.
- 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.
- Assists in developing practices to assist risk partners in managing financial risk.
- Identifies areas to improve provider service levels.
- Educates/enhances relationships within the provider community.
- Special projects as assigned or directed.
- Required A Bachelor's Degree in a related field
- Required or equivalent work experience in Network Development or Provider Relations
- Required 5 years of experience in the healthcare sector (preferably at HMO or PPO)
- Required 4 years of experience in HMO provider/hospital/ancillary contracting and network development
- Required 1 year of management experience
- Required Other Or 3 years of Supervisory, or Lead/Sr. role with demonstrated leadership ability or program management experience