Hearst Autos

Director, Product Provider Solutions

3+ months agoTampa, FL

Role Overview:

MHK is seeking an innovative thought leader with experience in provider management processes in the managed care or health plan industry. The ideal candidate will be passionate about adding value through software solutions that generate process efficiencies and improve member care. MHK is building an exciting new provider solution that allows health plans and other managed care entities to manage their provider data and networks in one holistic technology solution, with critical linkages to clinical and benefits data to allow plans to calculate and transmit network performance and cost of care in real time to members and providers.

This professional is responsible for leading the organization in researching and building new products, product enhancements and product redesign related to provider management processes. Will evaluate the potential and practicality of products in development and rely on extensive experience and judgment to plan and accomplish goals. This position requires exercising independent judgment to perform the responsibilities described herein while leading and collaborating on the ideal future state of software solutions addressing the many variables involved with provider management processes, associated data and downstream impacts.

Ideal candidate would have extensive network operations and provider relations experience in a managed care setting including knowledge about provider onboarding, credentialing, network creation (including adequacy), and network and demographic management (including accuracy of all elements). Experience with benefit creation and network quality and performance would also be key.

Responsibilities:

  • Work on an exciting new provider solution technology initiative for health plans
  • Originate new products in concert with customer needs and business model and lead strategy, plan, and drive technology to align health plan business needs in the provider space
  • Design a platform that contributes to lower health care costs and better patient experiences through the provider management software solutions
  • Create a compelling argument to entice health plans to commit to purchasing the provider solution as the value-based purchasing world emerges
  • Design solutions and logic to solve health plan needs related to provider management such as onboarding, credentialing, network management, etc.
  • Oversee key projects, processes and performance reports, data and analysis
  • Provide leadership and direction for all functions related to health plans utilizing the provider platform
  • Optimize business performance by coordinating with health plans, sales, compliance and IT development for all business purposes, and provide leadership and direction for all functions
  • Develop and implement methods and procedures for monitoring projects such as preparation of budget, research and development, progress reports, and staff conferences, in order to inform management of current status of each project
  • Negotiate contracts with consulting firms to perform research or development related to projects
  • Build a cohesive team by establishing clear direction, goals and responsibilities
Competencies:
  • Strategic Thinking
  • Problem Solving/Analysis
  • Understanding of healthcare landscape
  • Infrastructure and technical acumen
  • Business analysis and documentation acumen
  • Customer engagement
  • Leadership Skills
  • Personal Effectiveness/Credibility
  • Collaborative nature
Role Requirements:
  • Bachelor's degree in healthcare management, business administration, or related field, or relevant education/experience
  • Provider network and contracting expert with 5+ years of experience with health plan contracting at the management level
  • Experience with provider onboarding and conducting provider credentialing
  • Proven ability to design provider and network management solutions, including IT solutions for provider demographics, network maintenance and downstream communication
  • Experience presenting and communicating with all levels of organizations
  • Must be willing to challenge the standard thinking with new ideas, new approaches, and new solutions
  • Strong decision-making skills and the determination to see projects through to the end
  • Demonstrated skills in leadership, management, and collaboration
Role Desirables:
  • Master's degree
  • Experience with downstream provider risk and risk pool
  • Knowledge and experience in capitation management
  • Proven ability to drive network provider performance, including cost-effectiveness and quality metrics

Job ID: hearst-2010577