Sr. Network Development Manager, Managed Care Operations at Minneapolis

Job Description

Job Summary:

The primary role of the (Sr.) Network Development Representative is to develop and maintain positive, strong working relationships while serving as the key liaison between CollabHealth Plan Services and CHI healthcare delivery networks including Clinically Integrated Network entities, and comprehensive go to market provider networks. This position will provide excellent educational instruction, support and service to providers and their staff and projects a positive, professional image at all times. The Representative will negotiate contracts with network providers that meet determined guidelines and ensure the ongoing development of the network to meet the needs of assigned geographic territories, as well as CMS, Medicare and other stakeholder business and regulatory requirements

Essential Duties:

1. Member of the National Payer Strategy & Operations team

Analyze and make decisions regarding provider contracting in existing and expansion service areas, including decisions to contract, decisions not to contract, and at what unit cost within defined parameters.

3. Ensure enterprise-wide MC network compliance4. Support medical management through negotiation of spot contracts for non-participating providers5. Make presentations to provider groups and communicate directly with provider group representatives regarding policies and procedures, and provider based initiatives6. Ensures visit goals are met and/or exceeded and telephone outreach is completed timely and accurately documented.7. Ensures education and problem resolution for the provider network. Responsible for seeing that the provider education plan initiatives are performed, documented, reported and measured in accordance with policies and standards.8. Serves as a participant in meetings with network and key matrix partners.9. Coordinates communication materials to address specific market needs as required.10. Ensures offices are familiar with and demonstrate successful implementation of new policies and procedures, new contractual agreements, group-specific information, etc. In order to succeed and excel in this area one must develop and hone the ability to continuously absorb new information disseminated daily and immediately incorporate it into the education provided to the network.11. Creates effective working relationships by open and timely information sharing and effective collaboration with team, and internal and external customers so as to achieve company and department goals.12. Consistently projects a positive and professional image.13. Works well with others, understanding that the best results are achieved through promoting teamwork and collaboration among individuals with diverse skills, ideas and backgrounds, and by demonstrating versatility along with the ability to show appropriate sensitivity.14. Cultivate and maintain collaborative internal and external business relationships.

Work collaboratively with individuals responsible for delegation oversight to assure accreditation and regulatory compliance standards are consistently met.

In conjunction with medical management team to identify quality opportunities and identify any areas of concern regarding medical cost targets and develop action plans related to those areas.

17. Assists in the implementation of strategic network processes, including stakeholder orientation and training, and validates successful adoption and integration of new capabilities.18. Develops and maintains strong working relationships with functional area counterparts, and ensures coordination and collaboration across the system.19. Coordinates the institution of best practice sharing, internal and external stakeholder validation of the effectiveness of network operations capabilities and processes, including best use of management processes and technologies

Participates in and supports national payer strategy and operations initiatives, and shares expertise and bandwidth throughout the system as required

Job Requirements

Education / Accreditation / Licensure (required and preferred):Bachelor degree required; Masters in business, healthcare administration, or related field is preferred.Experience:

• 7-10 years direct experience in provider network development and related operations
• 5 years direct experience in hospital managed care contracting or equivalent health system knowledge base
• 5 years experience negotiating contracts that span the spectrum of Fee For Service through Value Based Pricing and Percent of Premium and/or Risk contracts
• Demonstrated ability to work effectively in a matrix-oriented organization

License/Certification:

• None

Additional Responsibilities:

• Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
• Adheres to and exhibits our core values:
  Reverence: Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.
  Integrity: Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.
  Compassion: Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.
  Excellence: Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
• Maintains confidentiality and protects sensitive data at all times.
• Adheres to organizational and department specific safety standards and guidelines.
• Works collaboratively and supports efforts of team members.
• Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.

Catholic Health Initiatives and its organizations are Equal Opportunity Employers. CBCHI

Shift: 1st

Scheduled Hours per 2-week Pay Period: 80

Weekends Required: None

Status: Full Time
Country: USA, State: Minnesota, City: Minneapolis, Company: Catholic Health Initiatives.