Senior Director, Network Management, Needed! Camarillo, CA
Company Description Under the general supervision of the Chief
Operations Officer, the Senior Director, Network Management is
responsible for leading all aspects of Provider Network Management
at the organization. Responsibilities of this position include the
development of the Plan’s provider network strategy, provider
contracting, provider relations and operations to support provider
service, network development, provider education, and product and
The Senior Director will plan, direct, and organize strategic
provider engagement activities with health systems, hospitals, and
provider groups to ensure effective support for improving the
health outcomes of health plan members, improving the quality of
care and service they receive and reducing the total cost of care.
The successful candidate provides direction and oversight to all
provider network development and maintenance as well as
coordination and deployment of reimbursement operations. This
position works in concert with the other areas of the organization
including health services, finance, compliance, government &
regulatory relations and senior leadership. Additionally, this
individual is a key contributor to the organization’s strategic
processes and partnering with key business areas such as
Job Description MAJOR FUNCTIONS AND ACCOUNTABILITIES:
Duties may include, but are not limited to, the following :
• Establish the Plan’s Network Management strategic vision,
objectives, and policies and procedures.
• Ensure that the Network Management Department has the
appropriate skills and expertise to meet the ongoing business
initiatives and create future leaders and staff bench strength
within the team.
• Provide leadership to the Network Management team in line line
with the organization’s core values by building a high performing
team, holding , team members accountable for results with in a
culture of collaboration, trust and respect, thatrespect holds team
members accountable for results.
• Negotiate, re-negotiate and execute physician and/or provider
contracts in accordance with company standards in order to maintain
and enhance provider networks while meeting and exceeding
accessibility, quality and financial goals.
• Design, develop and implement Value Based Programs that incent
and reward quality and meet the goals of “triple aim.”
• Oversee analysis of claim trend data and/or market information
to derive conclusions to support contract negotiations.
• Perform periodic analyses of the provider network from a cost,
coverage, and growth perspective. Provide leadership in evaluating
opportunities to expand or change the network to meet Plan
• Evaluate the provider network and implement strategic plans to
achieve organizational targets and financial objectives through
effective primary care, specialty, hospital and ancillary provider
contracting and contract management.
• Lead the health plan in network design and development
strategies to support the growth and performance objectives of the
• Build and develop strong relationships with the provider
community to ensure that contractual relationships lead to
meaningful and effective partnerships that balance the best
interests of the organization's members, providers and the Ventura
County healthcare community.
• Enhance the engagement and partnership between the plan and
its providers through effective leadership of the Provider Advisory
• Support the tracking and evaluation of health system, hospital
and provider group performance, including quality, experience, and
total cost of care.
• Strategically aligns resources by continuously planning and
organizing to meet initiatives.
• Establish quality control mechanisms for processes and
continuously strive to improve operational efficiency through
process redesign and data driven evaluation of performance.
• Collaborate on and coordinate activities with other
departments in the Health Plan and other divisions to support the
network and the members it serves.
• Ensure provider education (new provider orientation, provider
education/seminars, ongoing visits, meetings, provider
manuals/bulletins/newsletters, etc.) activities are done in a
timely and cost-effective manner to continuously improve
relationships with network providers and the delivery of care to
• Ensure compliance with applicable regulatory and internal
requirements, including network reports for the department and
other internal or external clients, regulators, and accrediting
• Oversee the development and distribution of provider education
information such as the Provider Manual, bulletins and newsletters.
Oversee continuing education of contracted providers related to
quality improvement and outreach initiations, such as HEDIS disease
management, health fairs, and other projects.
• Establish and ensure adherence to Medi-Cal and the
organization's policies and procedures for all functional areas of
• Develop, modify and implement an External Relations strategy
and program on an annual basis and monitor key metrics at staff
level to ensure a high quality of service delivery and resulting
Provider Satisfaction as measured by formal Provider Satisfaction
Surveys and resolution of escalated provider issues.
• Conduct an annual effectiveness review of all provider
• Work with the COO to develop future strategic plans for all
areas of Network Management.
Qualifications EXPERIENCE, TRAINING, AND QUALIFICATIONS:
Knowledge, Skills & Abilities
• Experience directing Network Management Contracting, Processes
& Services is essential. Experience must include knowledge of
managed care contracting and provider relations.
• Experience in managed care health plan policies and operations
(Medi-Cal managed care preferred)
• Experience in the development and implementation of value
based provider reimbursement programs.
• Business principles and techniques of administration,
organization, and management to include an in-depth understanding
of the key business issues that exist in the health care industry
serving a diverse social and ethnic population.
• Local, regional, state, and federal laws, ordinances,
regulations, codes, precedents, government regulations, executive
orders, and agency rules, as they relate to managed care, Medicaid
and other related business and policies governing managed care
issues and especially network requirements.
• Communicate effectively in writing, orally, and with others to
assimilate, understand, and convey information, in a manner
consistent with job functions.
• Represent the Plan effectively in contacts with providers,
representatives of other agencies, and the public.
• Advanced computer skills that include MS Office products.
Education and Experience
• A combination of experience and training that would provide
the required knowledge, skills, and abilities would be qualifying.
A typical way to obtain the knowledge, skills, and abilities would
• Bachelor’s degree from a regionally accredited college or
university in an appropriate discipline, e.g., Business, Health
Care or Public Administration is preferred. Advanced degree
• Previous experience dealing with Government programs both
Medicaid and Medicare.
• A minimum of seven years of experience with Network
Development and Management. Contracting and provider relations
expertise is required. Knowledge of Managed Care particularly
Medi-Cal is desired
Additional Information If you feel that you have the skills we
require, please respond to this posting with your contact
information and your resume in a Word document. We look forward to
hearing from you today!
Senior Director, Network Management, Needed!