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Director of Network Operations

Location Aurora, Colorado Job Number 992542 Date posted 09/08/2021
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Description:
Salary Range:  $71.39/hour - $83.99/hour




Accountable for provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Director, Network Operations requires an in-depth understanding of how organization capabilities interrelate across the function or segment.. Direct the KFHPCO Provider Operations Department in the design and execution of strategic and tactical plans consistent with health plan and delivery system objectives across Colorado. Will lead and direct committees and cross divisional workgroups regarding, but not limited to financial modeling, quality performance, cost reduction, and network access determinations. The Director, Network Operations manages provider data for the health plan and medical group, including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.. Responsible for executive level communications (verbal, written, presentations) and reporting on network department operational performance. Collaborate with contracting team on the execution of network optimization initiatives. Will be a subject matter expert within KFHPCO, conduct strategic planning, policy development and professional staff oversight and development. Develop and maintain integrated work processes to support the provider network. Accountable for ensuring KFHPCO is positioned to achieve cost, quality targets and a competitive advantage in the marketplace. Lead and mentor teams of professional operations staff and, through oversight of policies and processes. Will work with Compliance to ensure compliance with all state and federal regulatory requirements.




Essential Responsibilities:



  • 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.


Basic Qualifications:

 


Experience



  • 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.

     



Education



  • Bachelors degree OR four (4) years of experience in a directly related field.

  • High School Diploma or General Education Development (GED) required.

     



License, Certification, Registration



  • N/A

     



Additional Requirements:



  • 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.

     



Preferred Qualifications:



  • 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.


Primary Location: Colorado,Aurora,Waterpark I Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-CO-02|NUE|Non Union Employee Job Level: Director/Senior Director Department: Waterpark I - Grp Rltn-Health Care Proc Adm - 1608 Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

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.