Director, Provider Network Performance

Role and Responsibility:
•Provides expert leadership, analysis and ongoing support in the areas of provider network operations including Total Cost of Care (TCOC), value-based purchasing, and state or federal quality initiatives, business issue identification and analysis, business process redesign, application of best practice methodologies, and identification of strategic and financial opportunities / risks
•Collaborates as a change leader in translating issues, goals and objectives into practical and integrated solutions and services that help to ensure optimum business performance
•Oversees the development and application of policies, standards, benchmarks, and quality controls
•Develops metrics to ensure resources or services are responsive, tracked, enhanced, and deliver high value; educate executives and their colleagues on how to understand and improve performance
•Determines and recommends improvement alternatives
•Works in conjunction with staff, consultants, management and administration to design project plans, conduct studies, make recommendations and develop implementation plans for operations improvement that enhance productivity, resource utilization, and/or customer service
•Provides support to the Vice President, Network Strategy & Contracting for operating status reviews
•Provides assistance in both the analysis and implementation of initiatives specific to market service level agreements, employee engagement, quality, and compliance
•Understands, maintains, clearly articulates and incorporates advanced and current subject matter knowledge of best practice methods and tools to improve results, processes, services and productivity
•Develops and coordinates the implementation of performance improvement measurement, reporting and feedback systems
•Serves as system administrator for contract management databases; instructs site-specific user administrators, creates profiles for users, and coordinates upgrades with Information Technology
•Secures resources, defines roles and responsibilities, sets direction, aligns and coordinates initiatives relating to enhanced operational performance or sustained division goals
•May lead, direct and / or participate in the vendor selection process including identification, evaluation and selection, the development of contracts and agreements, and contract compliance for tools and services related to provider network operations strategic initiatives
•Communicates clearly and professionally with all levels of the organization, from executives to front line staff, demonstrating an executive presence
•Oversees and manages support teams, which includes responsibility for the hiring, supervision, development and evaluation of colleagues
•Prepares periodic written reports and makes presentations to executive leadership summarizing activities, accomplishments and future recommendations
•Maintains a working knowledge of applicable Federal, State and local laws and regulations
•Perform any other job related instructions, as requested

Required Education / Experience:
•Bachelor’s degree in management, healthcare management or related field or equivalent years of relevant experience is required
•Master’s degree in business, healthcare management or associated field is preferred
•A minimum of five (5) years of provider operations experience is required
•A minimum of five (5) years of leadership/management experience is required
•Managed Care experience is preferred

Required Competencies / Knowledge / Skills:
•Strong knowledge of Value Based Contracting methodologies and operations
•Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
•Ability to operate smart phone, iPad, or other mobile communication devices
•Knowledge of provider contracting and familiarity with provider network operations
•Knowledge of regulatory requirements for Medicaid, Medicare and Marketplace provider network operations
•Excellent oral, written and interpersonal communication skills to effectively interact, exercise discretion, judgment and diplomacy when dealing with internal and external customers
•Strong financial background
•Knowledge of managed care industry, trends, and accreditation, including quality improvement and NCQA provider network requirements
•Excellent leadership skills, with ability to effectively develop and manage a high performing team, and provide coaching and development
•Ability to work independently and within a team environment
•Attention to detail and work plan creation, implementation, and evaluation
•Business acumen and strategic thinking, yet able to execute tactically
•Demonstrated ability to adjust to shift priorities, multi-task, work under pressure and meet deadlines
•Proven ability to recognize opportunity for improvement and lead change
•Proven track record of leading teams focused on the consumer / member experience that demonstrated empathy and compassion and tracked results
•Proven track record in driving continuous improvement efforts to improve member experience and tracked results

Working Conditions:
•General office environment; may be required to sit / stand for long periods of time
•Ability to travel as required by the needs of the business

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