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Senior Manager, Network Operations
2 months ago
We are seeking a highly skilled Senior Manager to lead our Network Analytics team. As a key member of our organization, you will be responsible for providing strategic support to our contract negotiations, strategic initiatives, and regulatory requests.
Key Responsibilities- Lead Complex Analyses: Manage analysts in the design and execution of complex analyses to measure the financial impact of provider contracts and payment changes.
- Provider Contract Expertise: Maintain a broad, comprehensive knowledge and understanding of provider contractual arrangements, including value-based reimbursement mechanisms and key cost and utilization performance drivers.
- Financial Performance Improvement: Proactively lead the team to identify opportunities to improve our financial position through enhanced payment arrangements.
- Department Tool Development: Manage the development and enhancement of department tools to aid in standard department work, working with analytic staff to evaluate and recommend new and innovative financial models and processes.
- External Collaboration: Actively participate in external provider meetings with Network Contracting staff as needed.
- Network Adequacy and Access: Oversee analytics around network access and adequacy across all lines of business in accordance with compliance and regulatory requirements, leading analysts in measuring the impact of contracts on network adequacy and access.
- Team Management: Recruit, train, develop, and evaluate staff performance, managing the workload of the team to meet high quality standards and customer timelines.
- Education: Bachelor's degree required; master's degree in business administration, health policy, health economics, health services research, management science, medical sociology, or related field preferred.
- Experience: 7-10 years of experience with 3 years of effective supervisory experience.
- Skills: Advanced Excel skills; SAS/SQL programming required; in-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers; solid knowledge of healthcare claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment.
- Leadership: Ability to lead/mentor a team of staff effectively, meet changing business priorities, think strategically, understand and have insight into healthcare industry with an emphasis on managed care and finance-related issues.
- Communication: Excellent verbal and written communication skills; outstanding interpersonal skills.
