Provider Network Manager/Director

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The Company:

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.

The Culture:
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 Opportunity:
This Manager level position has two primary responsibilities of Provider Services Network Development as follows: (1) Actively seeking and initiating new provider development opportunities statewide across all islands, and following through with effective provider engagement in contract negotiations, through the full execution of a new or renewing provider contract. (2) Providing direct leadership, oversight, guidance and support to the Provider Relations staff, ensuring quality and timely staff performance and appropriate prioritization of workload.

Primary Duties and Responsibilities:
• Leads planning and implementation of provider network development and recruitment based on the organization’s network needs statewide.
• Develops and executes provider contracting strategies through leadership recommendations, provider proposals, comprehensive analysis, and direct negotiations of contract and compensation terms.
• Partners with Sr. Director of Network Development on value-based purchasing strategies (VBP).
• Works in partnership, collaboratively with Company Compliance, Legal counsel, Chief Financial Officer, and other departmental leaders to ensure appropriate use of provider contract templates and rate structures.
• Responsible for leadership, oversight and supervision of the Provider Relations staff to support AlohaCare’s strategic goals.
• Maintains provider relationships to identify and resolve issues and to initiate solutions to proactively address provider network needs.
• Coordinates with neighbor island Branch Managers to align provider service activities and processes as needed.
• Actively participates in inter-departmental collaboration for provider related projects, process improvement and on-going operations.
• Contributes to the development of provider communications, including surveys, directories, manuals, website and newsletters.
• Retention of providers – Assists staff in the development and implementation of provider retention plans, including resolution of provider and member issues including process improvement.
• Education of providers – Assists with development and implementation plans for provider education and training.
• Contractual and Accreditation reports – Assists with managing of production reports to fulfill contractual, regulatory and accreditation requirements.
• Responsible for staff development and training.
• Monitors and evaluates staff employee performance, including weekly attendance.
• Oversees and coordinates AlohaCare’s representation at external provider related events on Oahu including exhibit booths, conferences and task forces. May conduct educational presentations to providers as needed.
• Communicates will all internal and external stakeholders with diplomacy, professionalism and knowledge.
• 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.
• Bachelor’s degree
• Relevant work experience (5 years) in a health plan setting, physician group setting or hospital setting (Equivalent combination of education and experience will be considered), 7 years or more experience will be considered a director’s role.
• Must be able to work independently and employ strong time management and organizational skills
• Strong interpersonal communication skills, including strong written and oral communication skills
• Proven track record with provider contract negotiation
• Working knowledge of Medicaid and Medicare including languages and rates as well as NCQA requirements
• Ability to problem solve, analyze, think critically, exercise sound judgment and make fair decisions.
• Ability to multi-task, adapt to changing priorities, manage a diversity of high priority projects in a fast-paced environment.
• Demonstrated supervisory/leadership skills.
• Advanced skills using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
• Requires operation of general office equipment to include; PC, fax/copy machine and ACD Midel Phones.

Preferred Requirements
Public speaking experience
• Financial analytical skills to discern financial and performance risks

Mental, Physical and Environmental Demands:
• Valid driver’s license and access to an insured car.
• Ability to travel inter-state with occasional overnight stays.
• Available to work evenings and some weekends
• 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 Network and Computer

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.

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