Network Management Director - Oklahoma City, United States - CURAtive
Description
Manages complex contract negotiations with large and/or complex providers for commercial product lines (e.g., Ancillaries, large physician groups, some smaller hospitals).
Manages key provider relationships and is accountable for critical interface with providers and business staff.
Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive positionIdentify and manages initiatives that improve total medical cost and quality.
Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
Partner with Regulatory Affairs to ensure all network filings are timely and accurate.
Initiates, nurtures and maintains effective channels of communication with internal matrix partners including but not limited to Claims, Medical Management.
Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing.Duties And Responsibilities
Manages complex contract negotiations with large and/or complex providers for commercial product lines (e.g., Ancillaries, large physician groups, some smaller hospitals).
Manages key provider relationships and is accountable for critical interface with providers and business staff.
Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive positionIdentify and manages initiatives that improve total medical cost and quality.
Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
Partner with Regulatory Affairs to ensure all network filings are timely and accurate.
Initiates, nurtures and maintains effective channels of communication with internal matrix partners including but not limited to Claims, Medical Management.
Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing.Requirements
Bachelor's degree or equivalent experience in related field, plus 7+ years of work experience beyond degree within provider contracting and/or health insurance
At least 7 years of relevant managed care contracting experience; specifically focused on Texas hospital relationships and negotiations
Experience in developing and managing key provider relationships including senior executives
Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
Intimate understanding and experience with larger, more complex integrated delivery systems
Team player with proven ability to develop strong working relationships within a fast-paced organization
Nimble to pivot to different strategies, projects and priorities quickly
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
Seniority level
Seniority level
Director
Employment type
Employment type
Contract
Job function
Job function
Health Care Provider
Industries
Hospitals and Health Care
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