Manager Network Development

2 weeks ago

Plymouth, United States Fulcrum Health, Inc. Full time

ORGANIZATION

Fulcrum Health, Inc. is a nonprofit, physical medicine benefit management organization that has delivered quality care through its network of over 4,800 licensed and credentialed physical medicine service providers for over 40 years. Our product offerings include acupuncture, chiropractic, massage therapy, physical therapy, speech, and occupational services, serving over 2 million health plan members. Fulcrum continues to offer innovative and inspiring ways to leverage physical medicine that help lower health care costs, achieve better outcomes, and increase patient satisfaction.


POSITION PURPOSE

The Manager Network Development is a critical member of Fulcrum’s Network Management team. The position supports Fulcrum’s network recruitment and development. Responsibilities include driving Fulcrum’s provider network expansion efforts, creating targeted recruitment collateral in partnership with Marketing, performing detailed market analysis and intelligence gathering as well as maintaining network KPI reports and performance dashboards


ESSENTIAL FUNCTIONS

Network Development and Recruiting

  • Recruit and develop provider networks to meet on-going business and client benefit needs.
  • Develop geographically competitive, broad access, stable networks that achieve Fulcrum client objectives for performance, network adequacy and accessibility of provider specialty types.
  • Engage and contract with independent practitioners and provider groups to join Fulcrum network(s).
  • Participate in the development of business strategy to achieve contract objectives.
  • Adapt departmental plans and priorities to address business and operational challenges.
  • Work cross functionally to design and implement recruitment strategy and supporting collateral to drive Fulcrum network expansion and practitioner development initiatives.
  • Contracting, negotiating and timely onboarding of new provider contracts.


Market Intelligence and Analysis

  • Provide insightful competitive intelligence to inform leadership of industry trends, market composition and best practices related to provider network expansion.
  • Utilize technology tools and dashboards to track trends, generate reports and analyze expansion metrics to inform progress and support network management strategies.
  • Work cross functionally to develop performance metrics and create reports for business partners and clients.
  • Conduct periodic audits to ensure network adequacy requirements are met and ensure compliance with applicable regulations and polices.
  • Perform other related duties and projects as assigned.




REQUIRED QUALIFICATIONS: (Minimum qualifications needed for this position)

Education:

  • Bachelor's degree; Master's degree preferred.


Experience:

  • 3+ years of experience within a health care network management related role handling complex network providers with accountability for business results.
  • 3+ years' experience in the health care industry.
  • 2+ years' experience within provider contracting.
  • Experience in Provider Network Management, Provider Network Development, Talent Acquisition and/or Sales and Marketing a plus.


PREFERRED QUALIFICATIONS:

  • Knowledge of managed care, provider network management, and contracting principles
  • Understanding of health care contracts, applications, and products.
  • Demonstrated experience developing and maintaining high performing practitioner networks, ie: tiered, narrowed, value based, etc.
  • Knowledge of Resource Based Relative Values System (RBRVS) methodology.
  • Strong analytical skills to aid assessment of potential market expansion initiatives.
  • Working knowledge of claims processing systems.
  • Experience using sympler, GeoAccess, and other industry standard provider demographic tools
  • Demonstrated ability to lead multiple high-profile projects and see them through to completion.

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