Senior Manager, Contract Provider Network

Supports the growth of provider networks by facilitating communications with potential partners to fill service gaps or decrease costs. Contributes to provider satisfaction by overseeing the collaboration and/or creation of training materials to aid provider education and consulting on issues as they arise. Driving the use of best practices for analyzing provider data to assess network performance and enforcing the development of knowledge around contract and regulatory compliance including network adequacy, claims, disputes, and/or provider directories. Supports contract strategy network development by fostering a collaborative culture across workgroups to ensure provider strategies improve access to patient care. Supports continuous improvement efforts by leading teams to use data-driven approaches with provider data and/or managing resources for the implementation of continuous improvement efforts to aid providers and business goals.

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units. Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.


• Manages designated units or teams by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies. Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate. Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.


• Supports continuous improvement efforts by: leading teams to use data-driven approaches with provider, claims, and contracting data when identifying and/or consulting on continuous improvement opportunities across the contract ecosystem (e.g., identifying business and operational disparities between organizational and provider expectations, constraints, and risks to accessible care, building and maintaining relationships); managing resources for teams to implement process improvement initiatives to aid providers and business goals; overseeing teams collaboration with internal and external partners to develop network strategies and implement improved access to care; and may also include overseeing and guiding the conducting and/or collaboration on modeling and analysis of provider and market data to develop recommendations, solutions, and action plans for improvement initiatives.


• Ensures contract commitments are met by: driving the use of best practices for analyzing provider and contract data of the day-to-day operation and management of services to identify trends and consult on provider compliance; leading teams in the resolution of issues related to provider compliance with contract terms and conditions; enforcing the use of guidelines across teams to ensure provider compliance with state and federal regulations as well as KP policies and procedures; and overseeing teams in the consultation with Provider Systems Administration (PSA) or its equivalent as needed to ensure proper contract interpretation and operational readiness and driving corrective actions as identified through contract performance.


• Supports contract strategy development by: overseeing the development, proposal, and implementation of short-term strategies that improve the quality of and access to patient care while managing outside service costs; managing the consultation on local service delivery planning and delivery system leadership to aid in the achievement of provider priorities and strategies; fostering a collaborative culture across cross-functional workgroups and task forces to ensure provider strategies meet the unique needs of diverse stakeholders; and setting expectations and standards for peer training for new hires and contingent workers (e.g., establishing contract language, determining payment rate parameters, defining workflow and business processes, and ensuring cross-training across all service lines).


• Grows the Provider Network by: facilitating communications with potential partners/alliances to create relationships that fill service gaps or decrease costs in current service offerings; overseeing the development and maintenance of trusted partnerships with providers to understand their unique service request needs, challenges, and goals; serving as a trusted representative for providers and KP by ensuring the teams communication efforts provide transparency around issues and areas for improvement (e.g., contract compliance such as access, availability, referral operations, and/or supporting member complaints); and supporting provider site visits, daily interactions, and ad hoc meetings by ensuring objectives are met during the development of itineraries and agendas, gathering of credentialing materials, and/or initiation of this process.


• Contributes to provider satisfaction by: facilitating the development of knowledge of provider/contract operations across teams to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, other operational issues, and/or directories;collaborating with senior leaders to develop solutions to address provider questions and problems more efficiently; and overseeing the creation and delivery of training materials to aid provider education and orientation on health plan systems, processes, and/or credentialing.