Director of Network Operations
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- Provide leadership and direction in developing short and long-term strategies for Provider Network Development operational team, including establishment of vision, policy and operational processes in support of departmental, divisional and enterprise-wide objectives. Build and manage internal and external relationships. Provides direct linkages between inter-company and community providers and vendors. Coordinates departmental strategy & policy development with executive leadership. Evaluates and determines key contracting methodologies to be utilized to provide best in class unit price and operational goals/targets. Integrates contracting strategy with regional/district budgets, finance & rate setting, marketing, health plan operations, payment policy and care management. Establishes relationships involving a broad spectrum of community & national health care professionals through presentations, meetings, conferences and associations. Lead contract strategic development.
- Provides high-level consultative & technical expertise to key stakehoders, marketing, planning, product development committees and other key policy development forums. Responsible for developing and providing key information to be shared with internal and external stakeholders through a variety of formats. Advises & directs in planning, resource allocation and implementation of policy & process changes. Identifies business system, quality improvement and performance reporting requirements.
- Leads Network Operations Department. Develops and oversee departmental budget, operations and policies. Directs a team of professionals to achieve key objectives. In accordance with Network Management leadership, assures development & implementation of effective policies & systems related to provider network performance (contracting, unit cost targets, network adequacy, payment, dispute resolution, reporting and regulatory compliance). Establish contract and payment methodologies/policies and assures compliance. Monitor financial performance and provide strategic direction and oversight related to budgetary development, project plans and implementation schedules to meet divisional goals. Participate on division senior leadership team and communicate strategic direction to and decisions to appropriate audiences.
- Establishes, reviews & approves management work plans detailing objectives, budget impacts and strategies by division, service line, or department. Budget and provider reimbursement increases/decreases are determined as part of the overall budget.
- Minimum seven (7) years of health care provider experience.
- Minimum two (2) years of direct supervision.
- Minimum six (6) years of experience with Providers and Analytics.
- Bachelors degree OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
- Strong Excel Skills.
- Strong Network Operations acumen with proficiency in process, project management and auditing.
- Demonstrated understanding of Network Operations metrics and the ability to assimilate data from multiple reporting systems into actionable dashboards.
- Above average communication and presentation skills.
- Knowledge of managed care provider contracting and network management, business systems and financial reporting with strengths in health care finance, communication and negotiation strategies.
- Ten (10) years of progressive management level experience in provider contracting and provider network management and management of multiple business processes and systems.
- Five (5) years of direct experience supervision of Contract managers or related position.
- Management experience.
- High level presentation experience desired.
- Masters Degree in Business Administration or Finance.
- Masters degree in health care related field or business.
- Will have demonstrated progressive leadership accountabilities.
- Knowledge of legal and regulatory requirements pertaining to provider networks.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.