Executive Director of Network Development
1 week ago
As an Executive Director of Network Development at Pennsylvania Health & Wellness, you will play a critical role in shaping the company's provider network strategy. This position requires a seasoned leader with expertise in managed care network development and provider relations/contracting management.
Key Responsibilities:
Direct the provider network and contracting activities to ensure alignment with company goals and objectives.
Lead all aspects of provider network strategy, including access analysis, network operations, and support decision makers with analysis related to reimbursement and unit cost management.
Oversee the coordination and negotiation for the contracting department, establishing the department's strategic vision, objectives, and policies and procedures.
Develop, implement, and maintain production and quality standards for the Contracting department.
Oversee network development staff and external consultants in the development of provider networks across expansion markets.
Perform periodic analyses of the provider network from a cost, coverage, and growth perspective, providing leadership in evaluating opportunities to expand or change the network to meet Company goals.
Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts.
Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.
Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy.
Support market expansion and M&A activities by leading provider contract analysis related to due diligence.
Assist health plan CEO and/or COO vendors in key provider relations and strategy.
Requirements:
Bachelor's degree or equivalent experience in Business Administration, Healthcare Administration, or related field. MBA or MHA degree preferred.
10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment.
Previous management experience, including responsibilities for hiring, training, assigning work, and managing performance of staff.
What We Offer:
Competitive pay, health insurance, 401K, and stock purchase plans.
Tuition reimbursement, paid time off, plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules.
Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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