PURPOSE OF POSITION
To work independently or as part of a team in the recruitment of any of the following categories of healthcare providers: physicians, ancillaries and hospitals; negotiates competitive contracts; works on contracts that have moderate to high levels of complexity, impact and difficulty.
ESSENTIAL FUNCTIONS
PROJECT MANAGEMENT ACTIVITIES:
Develop project plans and goals for projects within assigned scope.
Monitor and generate status reports on network development activities for assigned projects.
Collaborate with Territory Director on network development and contracting activities.
May mentor other junior members of the network development staff.
PROVIDER NETWORK ACTIVITIES:
Recruit targeted physician groups, ancillary providers and hospitals to Company networks.
Develop negotiation strategy and conduct negotiations with specified providers.
Develop models for negotiations and what-if scenarios by using contract support system.
Respond to complex provider inquiries regarding company’s contract issues and administration, and reimbursement to facilitate recruitment activities.
Complete competitive assessment of markets and assist in development of network recruiting goals.
Develop recommendations on pricing, access, and other network features.
Coordinate the approval process of non-standard reimbursement arrangements.
Assist with the process for contract execution implementation.
Ensure that all provider contracts are produced in accordance with Company and Shareholder standards.
Develop positive relationships with providers, hospitals, and insurance carrier representatives. Respond rapidly and appropriately to issues that arise.
Assist carriers in pre-sale and post-sale education of employer groups, brokers or consultants.
Actively seek opinion of Company payors with regard to the composition and quality of Company networks. Propose appropriate revisions to current projects or future business plans.
Ensure that corporate legal files are maintained for specific contracted providers.
SUCCESS FACTORS:
Demonstrate an understanding of Company’s general business principles, industry dynamics, market trends, and specific operational details including current medical management, customer base competition, Network Management concepts, and CQI concepts when performing all aspects of the job.
Develop and maintain strong relationships with key providers in markets assigned through face to face visits and a good understanding of providers’ business needs. Travel is expected.
Keep the needs of external and internal customers as a priority when making decisions and taking action.
Identify or implement new or modified processes to accomplish the best results with the least time and resources.
Demonstrate written and verbal communication skills and convey information clearly and effectively.
Manage work time efficiently and effectively.
Demonstrate project management skills and effectively manage resources and workflow for multiple projects simultaneously.
Exhibit willingness to collaborate with others to ensure best practices; develop and maintain cooperative relationships with others at all levels of organization by consistently sharing information, workload and responsibilities; consult with colleagues/experts as needed.
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