Analyze assigned market needs, performs contracting functions, educates providers and provider service entities, maintain business relationships for the Health Plan(s), reports on provider and market changes, acts as a support for other service areas for the Health Plan(s).
Essential responsibilities include the following. Other duties may be assigned.
· Managing the negotiation and contracting providers and essential vendors to maintain CMS adequacy and providing necessary services in the care of the Plan members.
· Develop and maintain healthcare provider network in assigned region including contracting, credentialing, and educating on expectations and future activities.
· Insuring providers and essential vendors meet the credentialing requirements for their appropriate service lines.
· Educating providers on the overview of Health Plan(s) functions and roles in caring for its membership.
· To perform analysis of the Health Plan(s) provider network to maintain network adequacy on an ongoing basis.
· Understanding, educating and discussing basic financial analysis of current or potential contracts and payment arrangements with providers and their appropriate staff
· To work with and be involved in implementation as needed.
· Establish a positive work environment that encourages participation in process improvement and commitment to department/company success.
· Complete corporate assignments as assigned.
The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The qualifications express the minimum standards of education and/or experience for this position. Other combinations of education and experience, if evaluated and equivalent, may be taken into consideration.
· Bachelor's degree with preferred, but not required, emphasis in Healthcare Administration/related field or three years of experience in managed care network development/network services.
· Must be fluent in all current provider payment methodologies.
· Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships.
· Experience in the health care field required.
· Prior experience in network development / network services is preferred.
· Prior experience with acute and post-acute facilities is beneficial.
· Prior experience with Medicare Advantage plans is helpful.
Skills and Abilities
· Must be able to accept instructions and work independently in the completions of goals and assignments.
· Must have strong negotiation, organization, presentation and time management skills.
· Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals.
· Must be able to work effectively in a team environment.
· Excellent computer skills, including Microsoft Office Suite.
· Must be self-motivated, dependable, team and goal-oriented.
Work and Time Requirements
· Must be available to work 8 a.m. until 5 p.m. local time
· Position requires travel to network provider locations.
· Teleworking is an option if criteria are met.
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