An exciting opportunity at a rapidly growing national healthcare organization that is serving its members through a value-based, full-risk model for integrated post-acute and home-based care. our client has developed a unique care model leveraging data to push for better patient outcomes.
We are looking for a leader for all aspects of Provider Network Performance Management at the organization. Responsibilities include oversight of the provider network performance ensuring service level agreement and qualitative measures are achieved. This dynamic position is also responsible for implementation of operations for new health plans, strategic planning, KPI stewardship, and compliance with health plan delegation requirements.
- Leverage existing and develop departmental KPI’s for day-to-day management of productivity, SLA’s, and work functions to properly allocate resources.
- Work with senior management to support profitability, budget, and other financial performance goals.
- Implement and monitor existing departmental goals to ensure and maintain quality of work.
- Regularly evaluate the efficiency of business procedures according to organizational objectives and apply improvements.
- Provide oversight of delegated agreements, requirements, and activities by working business leads in key areas.
- Develop and maintain strong, positive relationships with health plans, referral sources, field staff, and business partners to achieve corporate goals.
- Liaise with superior to make decisions for operational activities and set strategic goals.
- Facilitates new processes or products, as needed, to maintain or acquire new business partners.
- Work with executive staff to develop future strategic plans for all areas of Network Management.
- Establish quality control mechanisms for processes and continuously strive to improve operational efficiently through process redesign and data driven evaluation of performance.
- Ensure compliance with policies, procedures, and standards to secure quality management and adherence to state, federal, and accreditation organization requirements.
- Ensure that standard operating procedures are adequate and followed within all market operations both network owned entities.
- Lead automated integration efforts within market operations that yield performance improvement that clearly outline an ROI that focus on qualitative and quantitative.
- Assist with monitoring and oversight of budget and driving factors.
- A minimum of ten years' of experience leading/directing Network Management Performance.
- Experience must include knowledge of provider relations.
- Bachelor’s degree in health services with a master’s degree in healthcare administration highly desired.
- Expert ability to quantify and qualify data using KPI’s.
- Excellent communication skills and situational awareness with an aptitude for prioritizing multiple projects and incoming information.
- Ability to grade and assess process improvement functionality in a quickly changing, fast-growth market.