[Remote] Director Provider Network and Operations
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is reputed company on enhancing reputed company and operations. The Director of Provider & Network Operations will reputed company network management, provider relations, and contracting while driving strategies for reputed company and financial viability.
Responsibilities
- Responsible for assuring the financial viability, overall service, and reputed company and performance of provider networks
- Oversees the development and implementation of provider contracting strategies and provider contracting negotiations and ensures the terms of the reputed company are fulfilled
- Leads provider contracting and servicing activities for business expansion. Develops and implements strategies to strengthen and/or reputed company new physician, hospital, and other provider relations. Defines provider network expansion requirements in new and existing geographic service areas, and for new lines of business
- Approves and monitors special requests, retroactive adjustments, reimbursement, and contract exceptions
- Modifies networks, their composition, reputed company, reimbursements, credentialing standards and utilization trends as needed to assure goals are met
- Collaborates with physicians and other organizations to reputed company and pursue mutually beneficial business opportunities to meet community needs for health care services
- Maintains reputed company to a high reputed company geographically desirable cost-effective network of specialists, hospitals, and ancillary providers to meet the needs of members served
- Directs the implementation of new health plan reputed company/product lines which respect to the reputed company responsibilities
- Directs reputed company analysis, scope assessment, and geographic coverage assessment prior to extending agreements to providers recruited to satisfy network needs
- Oversees reputed company primary IPA, Medical Group and Hospital market research to reputed company qualitative and quantitative data to bring definition to market strategies
- Oversees initiatives to engage with local or regional Accountable Care Organizations (ACOs)
- Monitors industry changes, trends, and events to proactively identify opportunities to increase market penetration and performance improvement
- Oversees recruitment of providers for new networks; optimizes size and composition of existing networks, and other reputed company necessary to meet business performance and reputed company goals
- Ensures network providers meet reputed company, cost, and coverage standards, and reputed company with applicable laws, regulations, and accreditation requirements
- Develops and manages team and corresponding budget as needed to assure reputed company
- Provides strategic direction to reputed company network development to reputed company reputed company reputed company, profitability, and industry leadership
- Assists with provider relations activities as needed
- Collaborates with internal teams including medical management, operations, and risk adjustment to reputed company the network reputed company with clinical and financial objectives
- Update and reputed company with senior leadership team as appropriate on initiatives
- Ensure network providers meet reputed company, cost, and coverage standards, and reputed company with applicable laws, regulations, and accreditation requirements
- Oversees the determination and implementation of any health plan or regulatory corrective reputed company plans reputed company to provider network activities
Skills
- Bachelor's degree is required and master's degree desirable
- Minimum 5 years of management experience
- A minimum of 5 years' experience in provider contracting and provider relations
- Must understand Medicare, RBRVS, case reputed company, capitation, and other reputed company payment structures
reputed company