Reporting to the Director, Strategic Expansion Partnerships, the Manager, Network Contracting, will work with the health plan’s leadership team to develop and implement partnerships with other healthcare systems. The Manager will assist in the exploration of expansion opportunities including the formation of new health plans, jointly owned by Sentara Healthcare and the other health system, that may offer Commercial, Medicaid and/or Medicare Advantage products. The Manager will need to work closely with and liaison other Optima and Sentara Healthcare system resources. Responsibilities will include:
a. Assist in due diligence effort and developing contract with business partner
b. Assist in developing a business plan and budget
c. Develop creative solutions to issues that arise
d. Develop and execute new provider network development strategies for new entities as appropriate which may include:
1. Ensuring proper network composition
2. Performing gap analysis
3. Negotiating competitive rates; hospital, physician and ancillary providers
4. Facilitating credentialing process and communication to providers
5. Assuring provider is educated on health plan reimbursement methodology, policies and procedures that may be required via contractual relationship
6. Post development ; assist in the transition of on-going responsibilities to new entity management
Requirements: Bachelor’s degree in business, finance, healthcare management or related field required. Minimum 6 years of progressive, relevant, healthcare / managed care experience required.
Knowledge and experience in the following areas required:
· Provider network development and contracting at a health insurance company, hospital system or managed care organization, handling complex providers with accountability for business results
· Health insurance/managed care products and operations
· Information systems and technology
· Knowledge of provider-owned health plans
· Experience reading and interpreting provider contracts
Other: Position will require extensive travel. Proficient with Microsoft Office products including Word, Excel and Power Point. Must be able to demonstrate effective presentation, written and verbal communication skills.
Optima Health - 15 months ago
You want a solid, growing career with a caring company.
We have a plan for that.
Being caring and supportive has always been our focus at...