Director of Network Development
Apply on line at http://www.alohacare.org/Careers/Default.aspx
AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.
AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.
These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.
The Director of Network Development leads the development and implementation of provider network strategies that drive provider satisfaction by delivering value to provider partnerships and collaboration to meet mutually beneficial goals for member access to quality care. Manages all administrative and operational aspects related to provider relations, credentialing and contracting and corresponding quality improvement activities and interventions operating in alignment with AlohaCare’s mission and goals/objectives while ensuring compliance with Federal/State laws, accreditation standards, and other AlohaCare contractual obligations. Collaborates with and ensures close coordination with other AlohaCare Divisions/Departments, in particular claims, health services, quality, finance, compliance and information systems, as well as external partners/sub-contractors as appropriate.
Primary Duties & Responsibilities:
• Lead and direct the management of the Network Development Department comprised of:
o Provider relations, responsible for the development and maintenance of a robust provider network that meets member and organizational needs by fostering provider collaboration and partnership;
o Credentialing, responsible for timely, accurate and consistent processes to ensure the provision of quality services for our members, as well as meet other organizational needs;
o Contracting, responsible for timely, accurate and consistent engagement of providers in contractual relationships with AlohaCare;
o Branch office management, responsible for oversight of Neighbor Island branch office operations, including front desk customer service, facilitation of facility related maintenance and equipment, and implementing organization-wide employee activities.
• Train, manage, mentor, develop and provide guidance to department staff to improve individual skill sets and develop subject matter experts to enhance job satisfaction, promote employee development and retention, and to ensure employee performance meets or exceeds expectations.
• Accountable for the establishment and maintenance of key performance indicators for timely and efficient processes and workflows.
• Ensure administration of the AlohaCare Medicaid QUEST Integration and Medicare Advantage Plus Special Needs Plan programs are compliant with Federal and State laws, accreditation standards, and other AlohaCare contractual obligations.
• Manage and maintain budgets, manpower and other resources.
• Facilitate effective external and interdepartmental communication using multiple mediums, including meetings, publications and group presentations.
• Responsible for apprising the Chief Customer Officer of the status of major activities and significant operational issues.
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
• Manages 6 subordinate managers/supervisors who supervise Network Development Department employees in the field and office.
• Is responsible for the overall direction, coordination, and evaluation of these units.
• Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws
• Responsibilities includes interviewing, hiring and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
• Bachelor’s degree in Health, business or other related field – Master’s preferred
• 5 years management experience in health care field
• 2 years Managed Care operations experience
• Demonstrated ability to lead at the executive management level
• Ability to function independently and supervise personnel; work closely with physicians, providers and members
• Expertise with provider fee schedules, pricing models and contract negotiation
• Demonstrated problem identification and problem solving skills
• Strategic thinker and relationship builder
• Excellent verbal, written and presentation skills
• Expertise with provider fee schedules, pricing models and contract negotiation
• Experience in network management and development
• Master’s Degree – Health, business or related field
• Medicaid and/or Medicare Special Needs Plan experience
• Ability to read, analyze, and interpret complex documents
• Ability to respond effectively to the sensitive inquiries or complaints
• Ability to make effective and persuasive speeches and presentations on controversial or complex topics to top management, public groups, and/or boards of directors
• Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions and deal with several abstract and concrete variables
• Proficient comfort level with computers, MS Office software programs, Outlook, and Internet usage
• Requires access to own transportation if needed to attend off-site meetings and ability to travel
Mental, Physical and Environmental Demands:
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
• Inside working conditions
• No environmental hazards
• Requires operation of general office equipment to include PC
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.Position Description »