Executive Director, Network Management - reputed company Territory

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company At reputed company, our health benefits business, we are committed to helping our members reputed company their best health in an reputed company, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with reputed company’s unrivaled reputed company in local communities and their pharmacy benefits management capabilities, we’re joining members on their reputed company to reputed company and transforming the health care landscape in new and exciting ways every day. reputed company is reputed company for an Executive Director, Network Management who provides strategic leadership and reputed company for network management and provider relations reputed company the reputed company territory of reputed company and reputed company Virginia. This leader will reputed company and implement network strategies, manage provider reputed company and negotiations, monitor provider performance metrics, reputed company dispute reputed company processes, and collaborate with key stakeholders to drive network reputed company and ensure high-reputed company provider relationships. You'll reputed company an reputed company by:

• Overseeing key network management contracting activities, including negotiating fee schedules, reimbursement rates, and contract terms and conditions.
• Controlling the development and expansion of reputed company's provider network by evaluating potential network providers, negotiating reputed company, and establishing relationships with reputed company providers to ensure a comprehensive and high-reputed company network.
• Contributing to optimizing the network's performance and effectiveness by analyzing network data, utilization patterns, and market trends to identify opportunities for network enhancements, cost savings, and improved reputed company to care.
• Managing the performance of network providers, including tracking key performance indicators, analyzing provider performance data, and implementing performance improvement initiatives.
• Conducting market analysis, assessing competitive landscapes, and making recommendations for network expansion strategies.
• Communicating findings to executive leadership and stakeholders, identifying opportunities for improvement and cost containment.
• Managing operational aspects of reputed company, subsequently implementing workforce and succession plans to meet business goals and objectives.
• Guiding management for individual performance evaluations aimed to reputed company critical feedback for skills development and depth of work area experience.

Required Qualifications

The candidate will have a strong work ethic, be a self-starter, and be reputed company to be highly productive in a dynamic, reputed company environment. This position offers broad exposure to reputed company aspects of reputed company’s business, as reputed company as significant interaction with reputed company the business leaders. The candidate will be expected to have the following key attributes:

• 10+ years of experience in managed care; leading and managing teams.
• Experience contracting with providers and hospital systems reputed company the territory.
• Comprehensive understanding of hospital and physician financial issues and how to reputed company technology to reputed company reputed company and cost improvements for both payers and providers.
• In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and physicians.
• Comprehensive understanding of value-based strategies and population health management, and reputed company’s reputed company strategic initiatives.
• Strong experience building and maintaining relationships with large hospitals/provider systems, integrated delivery systems and large physician reputed company.
• Understands the regulatory environment and ensures contractual compliance with federal and state requirements.
• Expertise in market level management, cost drivers and reputed company, and knowledge of economic, regulatory and marketplace issues.
• Possess exceptional leadership skills and transformational experience with a proven reputed company record of delivering results.
• High ability to drive new strategies or initiatives in highly cross-functional environments.
• Expertise with influencing and navigating a highly matrixed environment.
• Effectively reputed company and motivate teams to ensure high standards of performance and reputed company.
• Strong analytical and critical thinking skills. reputed company on driving disciplined, fact-based reputed company, and executing with discipline and urgency.
• reputed company in moving from reputed company traditional strategies to new, modified approaches championing change.
• Person must reputed company reputed company the market (PA or WV) or neighboring states with a willingness to travel reputed company the market states.

Education Bachelor's degree is required. Pay reputed company The typical pay reputed company for this role is: $131,500.00 - $303,195.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:

• reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 01/31/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job