Job ID: J127207
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Sep 6, 2018
I. GENERAL OVERVIEW:
This position is responsible for developing and implementing strategies for expanding the network of providers, leading a team of staff in the development, expansion, and contracting of providers; documenting pertinent information regarding potential providers; communicating with team on priority areas for development, supporting sales and RFP requirements on mapping/analysis; and strong financial preform analytic skills to understand the strategic impact of network affiliations and provider contracts. The individual is accountable for ensuring that the company secures stable provider networks that meet and/or exceed contractual access standards and accessibility in addition to formulating and administering department policies.
II. ESSENTIAL RESPONSIBILITIES:
1. Performs management responsibilities to include, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance a management and staff productivity.
2. Maintain executive coordination and collaboration to ensure network development alignment with corporate objectives.
3. Development of strategies and relationship models to address critical success factors across various lines of business for new and existing markets.
4. Interact with current, new, and prospective providers to ensure network expectations are communicated, understood, implemented, and maintained.
5. Coordinate network changes with all appropriate departments and design process improvements for inter-department communication. Review and implement changes to contracting operations to assure accurate processes and minimize inefficiencies and maximize cost savings.
6. Develop, produce, and distribute indicator reports and provider report cards.
7. Represent provider network on cross-functional teams and meetings, including new market rollout and network expansion.
8. Other duties as assigned or requested.
• A bachelor’s degree in Business or Health Administration or 10 years of relevant experience
• Three years’ Medicare and Medicaid experience
• Five years’ experience in provider network development
• Five years’ experience in Medicare and Medicaid
• Eight years’ experience required in provider network development
• Experience with provider profiling and alternative payment strategies
Knowledge, Skills and Abilities
• Possess a strong background in implementation and process improvement for provider network development
• Develop and maintain strategic level relationships with key medical delivery system partners
• Strength in leadership and teamwork, strategic thinking, influencing skills, negotiating skills, and operations execution
• Experience with financial terminology and analytics
IV. SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
V. WORK ENVIRONMENT
Is Travel Required?
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