Assistant Director Provider - Network Management

Summary: We are searching for an Assistant Director of Network Management - someone who works well in a fast-paced setting. In this position, you'll oversee the provider relations and satisfaction functions for the health plan and provider services by establishing and maintaining the necessary framework. You will also oversee the processesrequired to coordinate communication and programs to address the clinical and network needs of the health plan members and support members through the delivery system.   Think you've got what it takes? Responsibilities : Provide leadership in the development, direction, execution, and evaluation of an effective provider relations program that supports the delivery of quality healthcare most appropriately and effectively Manage internal and external relationships and consultations Streamline and manage processes to ensure effective coordination between network providers, care management, quality, claims, customer service, and networkcontracting Ensure analysis of utilization and cost data is translated to program implementation and support, maximizing health status of members and financial outcomes for the client Assist with the development and maintenance of a robust provider network that meets state defined accessibility standards and incorporates continuous quality improvement and effective outreach programming Plan, direct, staff, organize, and evaluate service models Evaluate and develop approaches, policies, and programs which are designed to meet goals and objectives based upon analysis of member and provider use patterns Implement readiness plans for product expansion, assimilation, and regulatory review Develop best practice models which are cost effective and provide quality service to members Mentor and develop staff toward expansion of professional roles to meet the continuous challenges and changes in managed care, contractual regulations, and legislative regulations, including promoting the ability to respond effectively to innovation and capacity management Perform special projects and other duties as assigned Qualifications: Bachelor's degree in business, healthcare, public health or related field required Five years of managed care experiencerequired Three years of leadership or management experiencerequired Master's degree may substitute for two years of experience requirements Knowledge of concepts and techniques central to managed care, care management, community health, and provider relations Knowledge of Medicaid and CHIP products Knowledge of applicable state and federal laws and regulations related to managed care practice Strong provider contract negotiation experiencepreferred   Job ID: 148665
Salary Range: NA
Minimum Qualification
5 - 7 years

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