Lead Director - Network Management

Description:

• The Lead Director, Network Management negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
• Manages contract performance and supports the development and implementation of value based contract relationships in support of business strategies.
• Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
• Accountable for cost arrangements within defined groups.
• Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
• Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities.
• Serves as SME for less experienced team members and internal partners.
• Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
• Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.
• May optimize interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met.
• Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Requirements:

• 10+ years of related health care experience in health operations, network relations/negotiations and development, command of financials and pricing strategies, and sales interface.
• Location Southern California - Highly Preferred
• Education : Bachelor’s degree or equivalent professional work experience.

Benefits:

• Affordable medical plan options
• a 401(k) plan (including matching company contributions)
• an employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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