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Date Added: Sat 18/07/2020

Director, Provider Network Management

Colorado Springs, Colorado, US
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Company: CENTENE

Job Type: Permanent, FullTime

Director, Provider Network Management

Position Purpose: Oversees and directs the strategic development and maintenance of regional and statewide networks of providers. Ensures the appropriate provider mix to meet marketing, financial, and regulatory strategic objectives. Accountable for the implementation of new products within the region and ensures the region's network development/expansion, and supports and contributes to the overall vision and direction of Health Net

- Oversees continuous provider network development and expansion to support the organization's current and future products.

- Develops goals, work plans and schedules for provider staff and ensures that they are executed. Responsible for the day-to-day supervision and monitoring of contracting staff and negotiations, provider services administration and operation for regional and statewide providers. Responsible and held accountable that overall region/statewide/national provider databases are maintained current and accurate, and information is presented internally and externally in a timely and professional manner.

- Oversees and directs all provider contracting strategies and efforts to ensure the achievement of corporate growth and cost objectives. Within accepted Health Net practices, has authority to finalize and close contract negotiations.

- Establishes and maintains superior provider relations through the development of effective and efficient services programs, as well as maintaining strong provider relationships.

- Monitors compliance and financial performance for all providers. Takes the appropriate action to ensure compliance with company policies and governmental regulations.

- Monitors capacity of existing networks, negotiates for additional capacity or explores other alternatives. Provides assistance and education to support new programs and products.

- Facilitates and assists with problem resolution related to numerous entities including, but not limited to, providers, marketing, claims, member relations and employer groups.

- Supports Sales and Marketing efforts through network development and negotiations of acceptable rates.

- Ensures that staff is adequately trained in all skills necessary and appropriate to their job, including but not limited to the following areas: contract negotiation and/or interpretation and clarification, marketing programs, Health Net products, customer service, provider network management and project management.

- Consults with Organizational Effectiveness on human resources related issues, including but not limited to hiring process, conflict resolution, staff development, and performance evaluations.

- Significant health care cost budget responsibilities and impacts. Monitoring and meeting budgetary goals on a regular basis.

Travel may be up to 40% after COVID

Education/Experience: Bachelor's degree required, or related field or equivalent health care experience; Master's degree preferred.

Eight to ten years experience with extensive provider network.
Health Net experience preferred.

Management/Health Care Management experience, which a minimum of six years was external management experience or four years internal Health Net management experience.
Experience in a Health Care Management environment, which provided exposure to provider contracting, servicing, benefits interpretation, and internal operations of provider relations function.

Expert knowledge of negotiation skills gained through experience.

This position will be supporting a Federal government contract, therefore it requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Network Development & Contracting

USA-Colorado-Colorado Springs


Federal Services

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