Dir, Corp

**Profile**:
Veterans, Reservists, Guardsmen and military family members are encouraged to apply

We offer remote work opportunities (AK, AR, AZ, *CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)

**Job Summary**

Director will focus on expanding and strengthening our provider network through strategic recruitment of designated Corporate and National providers across all states for which TriWest is responsible to serve VA (CCN) and DHA (TRICARE). This role includes identifying, recruiting, and managing providers to include health systems, hospitals, ancillary providers, and other health delivery entities which cross one or more state boundaries. Negotiates and maintains all provider contracts including discounts, credentialing requirements, and provider data compliance. Supervises a team of contracting specialists. Ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives. Reports to the Vice President of Provide Network Development.

**Education & Experience**

**Required**:

- Bachelor's degree in Business, Health Care Administration, or equivalent experience
- 8+ years’ experience in a managed care environment that includes provider contracting and negotiation experience within multiple states and/or territories
- 5+ years’ management experience in the healthcare industry

**Preferred**:

- Experience in provider contracting for government programs and/or commercial lines of business
- Experience in management/supervision of provider contracting staff in a managed care environment
- Experience in utilizing a contract management system to manage contracting workflow
- Familiarity with Medicare payment and claims processing rules

**Key Responsibilities**
- Builds and maintains an adequate network of corporate and national providers that meet or exceed all required access standards.
- Directly recruits large healthcare systems and network affiliates to support the network requirements for VA and DoD contracts.
- Develops and maintains strong relationships with assigned providers.
- Develops negotiation strategies to achieve department performance objectives.
- Negotiates and secures contracts, including associated discounts, for all corporate and national provider entities.
- Coordinates credentialing and data compliance with Provider Network Management team.
- Monitors network to ensure adequacy is being achieved and institutes corrective actions to address shortfalls in network.
- Monitors and ensures resolution of routine and escalated provider issues.
- Communicates information regarding market needs, competition, and industry trends to management team.
- Provides training and development to team members.
- Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
- Maintains client confidence and ensures confidential information is protected.
- Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
- Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
- Provides development and training to Network Providers on changes and updates to TriWest processes and policies.
- Monitors productivity, quality and quantity of work performed by staff related to provider contracting.
- Demonstrates and maintains current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
- Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.

**.**:

- Collaborates closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes.
- Heads or participates in projects and committees assigned by Director or Vice President.
- Performs other duties as assigned.
- Regular and reliable attendance is required.

**Competencies**

**Communication / People Skills**:Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

**Empathy / Customer Service**:Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.

**Independent Thinking / Self-Initiative**:Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

**High Intensity Environment**:Ability to function in a fast-