Director of Network Management

Summary:  The Director of Network Management will manage provider relationships, network development and contracting.

Essential Duties and Responsibilities include the following:  The Director of Network Management shall work with the Regional Vice President in building and maintaining a positive relationship with the providers in his/her designated geographic area. This is accomplished by ensuring timely and accurate credentialing, demographic and contract maintenance, education and through effective and proactive issue resolution. This position will direct and guide the Provider Relations staff.  Areas of network development are identified and actions implemented to assure a marketable provider network.  The Director of Network Management will work collaboratively with sales, claims, utilization management, and other resources, both internal and external.  Duties include, but are not limited to:Network DevelopmentProvider RelationshipsProvider EducationProvider Data MaintenanceProvider ContractingProvider Technology UsageDevelop of Internal Processes and ProceduresIssue ResolutionOther duties as assigned

Supervisory Responsibilities:  Internal and external Provider Relations representatives.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Strong oral and written communication skillsStrong presentation and team facilitation skillsAbility to perform/oversee multiple projectsExperience with provider relationship management. Understanding of insurance claims processing. Understanding of medical management processExperience with contract negotiation and interpretation of contractual language

Role Essentials

Education and/or Experience  

BS/BA in business administration, health care or a related field.  7+ years of insurance industry experience, preferably with an emphasis on provider administration, contracting and operations; 5+ years of supervisory experience; or equivalent combination of education and experience.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of organization.

 

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

 

Reasoning Ability  

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations.

 

Computer Skills  

Must be proficient in MS OFFICE with emphasis on Word and Excel.

 

Certificates, Licenses, Registrations

None.

 

Other Skills and Abilities  

 

Other Qualifications  

 

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.