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Director, Provider Contracting

In United States

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Director, Provider Contracting   

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JOB TITLE:

Director, Provider Contracting

JOB TYPE:

JOB SKILLS:

JOB LOCATION:

Renton, WA United States

JOB DESCRIPTION:

Accountable for all phases of planning and execution of strategies designed to produce the highest level of performance by the Provider Contracting Department in support of the enterprise-wide Client's Business Plan. Direct the Client's Provider Contracting Department in the design and execution of strategic and tactical plans consistent with health plan and delivery system objectives across Washington State and Northern Idaho. Will lead and direct committees and cross divisional workgroups regarding, but not limited to financial modeling, quality performance, cost reduction, and network access determinations. Position will build and manage key internal and external relationships, in collaboration with health plan and Care Delivery leadership. Responsible for executive level communications (verbal, written, presentations) and reporting on network performance. Direct team execution of network optimization initiatives. Will represent client at outside activities/meetings and be a subject matter expert within client, conduct strategic planning, policy development and professional staff oversight and development. Develop and maintain integrated work processes to support the provider network. Accountable for ensuring client is positioned to achieve cost, quality targets and a competitive advantage in the marketplace. Assemble, direct, and lead negotiating and oversight teams for client most complex multi-million dollar contracts. This includes relationship building and strategic oversight. Lead and mentor teams of professional contracting staff and, through oversight of policies and processes. Will work with Compliance to ensure compliance with all state and federal regulatory requirements.

Essential Responsibilities:
  • Provide leadership and direction in developing short and long-term strategies for Provider Contracting and Network Development, including establishment of vision, policy and operational processes in support of departmental, divisional and enterprise-wide objectives.Build and manage internal and external relationships. Provides direct linkages between inter-company and community providers and vendors. Coordinates departmental strategy & policy development with executive leadership. Evaluates and determines key contracting methodologies to be utilized to provide best in class unit price and operational goals/targets. Integrates contracting strategy with regional/district budgets, finance & rate setting, marketing, health plan operations, payment policy and care management. Establishes relationships involving a broad spectrum of community & national health care professionals through presentations, meetings, conferences and associations.Lead contract strategic development.
  • Provides high-level consultative & technical expertise to delivery system leadership, marketing, planning, product development committees and other key policy development forums. Responsible for developing and providing key information to be shared with internal and external stakeholders through a variety of formats. Advises & directs in planning, resource allocation and implementation of policy & process changes. Identifies business system, quality improvement and performance reporting requirements.
  • Leads Provider Contracting Department. Develops and oversee departmental budget, operations and policies.Directs a team of professionals to achieve contracting objectives. Assures development & implementation of effective policies & systems related to provider network performance (contracting, unit cost targets, network adequacy, payment, dispute resolution, reporting and regulatory compliance). Establish contract and payment methodologies/policies and assures compliance.Monitor financial performance and provide strategic direction and oversight related to budgetary development, project plans and implementation schedules to meet divisional goals.Participate on division senior leadership team and communicate strategic direction to and decisions to appropriate audiences.
  • Establishes, reviews & approves management work plans detailing objectives, budget impacts and strategies by division, service line, or department. Budget and provider reimbursement increases/decreases are determined as part of the overall budget. Reviews, approves, and signs provider contracts & third party provider agreements on behalf of the organization. Assess and inform the organization on national and local trends in contracting, payment policy and network design.
Qualifications:
Basic Qualifications:
Experience
  • Minimum seven (7) years of health care provider experience including minimum five (5) years of direct health care contracting negotiations experience.
  • Minimum two (2) years of experience in direct supervision of provider contract managers.
Education
  • Bachelor's degree in business or related field.
License, Certification, Registration
  • N/A

Additional Requirements:
  • Knowledge of managed care provider contracting and network management; business systems and financial reporting with strengths in health care finance, communication and negotiation strategies.

Preferred Qualifications:
  • Ten (10) or more years progressive management level experience in Provider Contracting and Provider Network Management and management of multiple business processes and systems.
  • Five (5) years of direct experience supervision of Contract managers or related position.
  • Master's degree in health care related field, business or juris doctorate.
  • Demonstrated progressive leadership accountabilities.
  • Knowledge of legal and regulatory requirements pertaining to provider networks.
  • High level presentation experience desired.

#Leadership

Employee Status:
Regular
Travel:
No
Job Level:
Director/Senior Director
Job Type:
Standard

Position Details

POSTED:

Dec 01, 2022

EMPLOYMENT:

INDUSTRY:

SNAPRECRUIT ID:

S16529544415243663

LOCATION:

United States

CITY:

Renton, WA

Job Origin:

OORWIN_ORGANIC_FEED

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In Dallas Fort Worth
Aug 19, 2017 9am-6pm
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Director, Provider Contracting    Apply

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<div> <div>Accountable for all phases of planning and execution of strategies designed to produce the highest level of performance by the Provider Contracting Department in support of the enterprise-wide Client's Business Plan. Direct the Client's Provider Contracting Department in the design and execution of strategic and tactical plans consistent with health plan and delivery system objectives across Washington State and Northern Idaho. Will lead and direct committees and cross divisional workgroups regarding, but not limited to financial modeling, quality performance, cost reduction, and network access determinations. Position will build and manage key internal and external relationships, in collaboration with health plan and Care Delivery leadership. Responsible for executive level communications (verbal, written, presentations) and reporting on network performance. Direct team execution of network optimization initiatives. Will represent client at outside activities/meetings and be a subject matter expert within client, conduct strategic planning, policy development and professional staff oversight and development. Develop and maintain integrated work processes to support the provider network. Accountable for ensuring client is positioned to achieve cost, quality targets and a competitive advantage in the marketplace. Assemble, direct, and lead negotiating and oversight teams for client most complex multi-million dollar contracts. This includes relationship building and strategic oversight. Lead and mentor teams of professional contracting staff and, through oversight of policies and processes. Will work with Compliance to ensure compliance with all state and federal regulatory requirements. <div><br /> <strong>Essential Responsibilities:</strong></div> <ul> <li>Provide leadership and direction in developing short and long-term strategies for Provider Contracting and Network Development, including establishment of vision, policy and operational processes in support of departmental, divisional and enterprise-wide objectives.Build and manage internal and external relationships. Provides direct linkages between inter-company and community providers and vendors. Coordinates departmental strategy & policy development with executive leadership. Evaluates and determines key contracting methodologies to be utilized to provide best in class unit price and operational goals/targets. Integrates contracting strategy with regional/district budgets, finance & rate setting, marketing, health plan operations, payment policy and care management. Establishes relationships involving a broad spectrum of community & national health care professionals through presentations, meetings, conferences and associations.Lead contract strategic development.</li> <li>Provides high-level consultative & technical expertise to delivery system leadership, marketing, planning, product development committees and other key policy development forums. Responsible for developing and providing key information to be shared with internal and external stakeholders through a variety of formats. Advises & directs in planning, resource allocation and implementation of policy & process changes. Identifies business system, quality improvement and performance reporting requirements.</li> <li>Leads Provider Contracting Department. Develops and oversee departmental budget, operations and policies.Directs a team of professionals to achieve contracting objectives. Assures development & implementation of effective policies & systems related to provider network performance (contracting, unit cost targets, network adequacy, payment, dispute resolution, reporting and regulatory compliance). Establish contract and payment methodologies/policies and assures compliance.Monitor financial performance and provide strategic direction and oversight related to budgetary development, project plans and implementation schedules to meet divisional goals.Participate on division senior leadership team and communicate strategic direction to and decisions to appropriate audiences.</li> <li>Establishes, reviews & approves management work plans detailing objectives, budget impacts and strategies by division, service line, or department. Budget and provider reimbursement increases/decreases are determined as part of the overall budget. Reviews, approves, and signs provider contracts & third party provider agreements on behalf of the organization. Assess and inform the organization on national and local trends in contracting, payment policy and network design.</li> </ul> </div> <h5 class="m-t-lg m-b-xs"><strong>Qualifications:</strong></h5> <div> <div><strong>Basic Qualifications:</strong></div> <div><u>Experience</u></div> <ul> <li>Minimum seven (7) years of health care provider experience including minimum five (5) years of direct health care contracting negotiations experience.</li> <li>Minimum two (2) years of experience in direct supervision of provider contract managers.</li> </ul> <div><u>Education</u></div> <ul> <li>Bachelor's degree in business or related field.</li> </ul> <div><u>License, Certification, Registration</u></div> <ul> <li>N/A</li> </ul> <div><br /> <strong>Additional Requirements:</strong></div> <ul> <li>Knowledge of managed care provider contracting and network management; business systems and financial reporting with strengths in health care finance, communication and negotiation strategies.</li> </ul> <div><br /> <strong>Preferred Qualifications:</strong></div> <ul> <li>Ten (10) or more years progressive management level experience in Provider Contracting and Provider Network Management and management of multiple business processes and systems.</li> <li>Five (5) years of direct experience supervision of Contract managers or related position.</li> <li>Master's degree in health care related field, business or juris doctorate.</li> <li>Demonstrated progressive leadership accountabilities.</li> <li>Knowledge of legal and regulatory requirements pertaining to provider networks.</li> <li>High level presentation experience desired.</li> </ul> <p><span>#Leadership</span></p> </div> <h5 class="m-t-lg m-b-xs"><strong>Employee Status:</strong></h5> Regular <h5 class="m-t-lg m-b-xs"><strong>Travel:</strong></h5> No <h5 class="m-t-lg m-b-xs"><strong>Job Level:</strong></h5> Director/Senior Director <h5 class="m-t-lg m-b-xs"><strong>Job Type:</strong></h5> Standard</div>


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