Director, Network Management-Health Plan

Location:

Calmont Operations Building

Department:

Network Mgmt

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Additional Information:

Plans, organizes, staffs, and coordinates all activities of the Health Plans Network Management Department. Works with Staff and Senior Management to develop and implement provider contracting strategies and provider service strategies to improve member access and enhance Provider satisfaction with the Health Plan. Primary Health Plan liaison for Claims, Member Services, Care Management, and other key departments within the Health Plan. Responsible for facilitating positive, professional relationships within the managed care organization, Providers, and the community. Responsible for the oversight and management of all physician, hospital and ancillary provider relationships.

Education/Experience:

• Bachelors degree required, MBA preferred.
• Advanced training in healthcare, business, or a related field required.
• Five to Ten years operational experience in a health care organization preferably in the area of provider network management.
• Minimum of five years team management experience.
• Must demonstrate proven success in establishing and maintaining positive working relationships with health care providers and their staffs.
• Working knowledge of HMO business operations specifically the functions of utilization management, member services, claims, credentialing and benefit plan interpretation.
• Experience preparing and presenting information to individuals and groups. Must be attentive to detail, have excellent organizational, problem solving, verbal and written communication skills.
• Strong customer service orientation and skill set.
• Must be able to work independently and actively participate as an integrated team member.
• Analytical thought processes and strong organizational, conflict resolution, and facilitation skills.
• Team and collaboration oriented, performance driven.