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Director of Contracting and Network Development

2 months ago

Cold Brook, New York, United States CareSource Full time
Job Summary:

The Director of Contracting and Network Development is responsible for executing a comprehensive contracting strategy, developing provisions based on cost, quality, and analysis, and monitoring key metrics to ensure the optimal performance of the provider network.

Key Responsibilities:

  • Conduct annual effectiveness reviews of contracting strategies to ensure corporate compliance with all contracting regulations.
  • Develop and implement strategies to ensure an ongoing high level of staff engagement, empowerment, and development.
  • Recruit and implement contracts with healthcare providers to ensure a high-quality network that meets corporate and regulatory requirements.
  • Develop and maintain contract language and templates in collaboration with the legal department.
  • Administer provider contracts, terms, reimbursement rates, and other contractual agreements in compliance with corporate policies.
  • Implement an efficient and effective process for onboarding new providers, ensuring the network is adequate, cost-effective, competitive, and stable.
  • Ensure all regulatory requirements for the provider network are met, including compliance with federal, state, and local regulations.
  • Perform gap analysis to identify and mitigate risks, and develop corrective action plans as needed.
  • Manage access grievances, analyze performance, and implement improvement initiatives to enhance provider satisfaction scores.
  • Participate in training sessions for providers and staff as required.
  • Support the contracting requirements of the corporation for geographic regions and products.
  • Implement performance improvement initiatives to enhance provider satisfaction scores incrementally on an annual basis.
  • Assist with the development and review of payment policies and provider notifications.
  • Collaborate with personnel to reassign members related to provider terminations, as required by the state.

Requirements:

  • Bachelor's degree in a healthcare-related field or equivalent work experience is required.
  • Master's degree or equivalent work experience is preferred.
  • Minimum three years of contract negotiation experience is required.
  • Minimum three years of management experience is required.
  • Managed care experience is highly preferred.

Competencies, Knowledge, and Skills:

  • Intermediate proficiency level with Microsoft Office applications, including Outlook, Word, and Excel.
  • Knowledge of network management processes and services.
  • Ability to manage and prioritize multiple tasks, promote teamwork, and fact-based decision making.
  • Effective oral and written communication skills.
  • Critical listening and thinking skills.
  • Training and teaching skills.
  • Time management skills.

Licensure and Certification:

  • Influenza vaccination is a requirement of this position to protect employees, members, and the communities served from acquiring communicable diseases.
  • CareSource adheres to all federal, state, and local regulations and provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law.

Working Conditions:

  • General office setting with a moderate noise level.
  • Reasonable travel, up to 30%, to fulfill the duties of the position.