Department: Network Management
Reports to: Market VP
Location: 949 Kamokila Boulevard, Kapolei, HI 90707
Directs a team in managing physician contracting, network development, provider relations and provider operations. Develops, executes and maintains a provider network strategy. Continuously evaluates network to ensure cost effective, optimal functionality. Works in concert with medical management and sales to develop strategies to meet market growth and medical cost targets.
- 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 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 field
- Required or equivalent work experience
- Preferred A Master's Degree in a related field
- Required 10+ years of experience in healthcare sector (preferably at HMO or PPO)
- Required 7+ years of experience in HMO provider/hospital/ancillary contracting and network development
- Required 5+ years of management experience
- Advanced Demonstrated organizational skills
- Advanced Demonstrated leadership skills
- Advanced Other Knowledge of regulatory requirements concerning Medicare and Medicaid
- Advanced Other Knowledge of provider contracts and health care reimbursement
- Intermediate Other Understanding of regulatory compliance management and reporting requirements
- Intermediate Other Ability to manage complex transaction and service models
- Intermediate Other Demonstrated proficiency in establishing and driving medical cost management programs
- Intermediate Other Ability to negotiate effectively with internal/external stakeholders, large hospital and physician healthcare systems