Provider Network Director jobs in the United States
Provider Network Director directs and develops a healthcare provider network. Designs and administers policies and services that comply with all contractual and regulatory requirements. Being a Provider Network Director requires a bachelor's degree. Typically reports to top management. The Provider Network Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Provider Network Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Recently Added Provider Network Director jobs
Director, Network & Provider Analytics
- Point32Health
-
Canton, MA
FULL_TIME
-
Who We Are
Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.
Job Summary
Reporting to the Vice President of Network and Provider Performance Management, the Director of Network and Provider Analytics plays a strategic leadership role with the Provider Partnerships organization. The Director manages a team of managers and analysts, working in a matrix environment to support and collaborate with colleagues from System Contracting, Ancillary Contracting, Actuarial, Sales and Provider Performance. He/she oversees the development and timely delivery of relevant and meaningful financial analyses in support of Point32Health’s provider contracts and network performance for all commercial and government payor lines of business.
The Director is will closely collaborate with Commercial and Enterprise functions in delivering the business goals with a strong and collaborative relationship with Finance, Corporate Data & Analytics (CD&A), and Health Care Services, and IT to leverage enterprise solutions built to support business performance. The position will have extensive interaction with the Chief Financial Officer, Chief Actuary, Head of Health Care Services, Chief Information Officer, and other executive leaders across the Enterprise. The Director will also represent the Commercial division’s vision and thought leadership in the areas of network performance and optimization, business intelligence, analytics and insights, and key systems selection and/or enhancements.
Key Responsibilities/Duties – What You Will Be Doing- Proactively identify and oversee the development of analyses, models, and tools to offer an informed view of provider, network, and contract performance
- In collaboration with System and Ancillary Contracting leadership, formulate and execute on strategies to improve unit cost, standardize reimbursement methodologies, and maintain competitive provider networks
- Provide direction and define approach and parameters for overall reimbursement strategy and payment methodologies, with the goal of standardization, optimization, and transparency. Oversee development of provider rates in line with negotiated terms
- Oversee the submission of regulatory submissions and requests
- Monitor, analyze and report on competitive position for all applicable Point32Health markets
- Produce accurate and timely reporting on network access and adequacy, ensuring standards are maintained and gaps are appropriately addressed
- Engage with Sales team to provide compelling information and reporting in support of employer account engagement, actively participating as a subject matter expert in cross-departmental as well as external provider and broker meetings.
- Actively represent the Provider Partnerships organization in Corporate Data & Analytics, Finance, Actuarial, Trend, Health Care Services, Information Technology, and other department and enterprise governance forums. Provide thought leadership, express business needs, and manage relationships with key internal constituencies
- Accountable for ensuring the team adheres to enterprise data and analytics governance standards, policies, and procedures
- Recruit, retain and develop talent. Coach and support staff in analytics, leadership and relationship management to enable a high-performing team
- Other duties and projects as assigned
EDUCATION, CERTIFICATION AND LICENSURE:- Bachelor's degree in business, health administration, finance or a related field
- Master's degree preferred, or relevant experience
- At least 10 years of progressive analytic, financial, project and/or operational experience in healthcare with 3 or more years of effective supervisory experience
- Energetic, goal-oriented leader with a proven ability to deliver results and lead teams to achieve goals
- Strong working In-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers; solid knowledge of health care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment
- Prior experience with Business Intelligence tools such as MicroStrategy, Tableau or SAS
- Excellent quantitative skills with ability to synthesize financial information, create and evaluate options
- Ability to manage and direct multiple priorities across teams while meeting aggressive deadlines
- Must have proven ability to work effectively across all levels of the organization on complex issues
- Excellent verbal & written communication skills
- Energetic and proactive individual who strikes the right balance between self-initiative and collaboration with others
- Demonstrated ability to master new content quickly
- Strong analytic and technical skills with the ability to translate complicated data into useable information
- Excellent verbal and written communication skills
- Must have the ability to lead/mentor a team of staff effectively, meet changing business priorities, think strategically, understand and have insight into health care industry with an emphasis on managed care and finance related issues.
- Must be able to work under normal office conditions and work from home as required.
- Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
- May be required to work additional hours beyond standard work schedule.
Compensation & Total Rewards Overview
As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:- Medical, dental and vision coverage
- Retirement plans
- Paid time off
- Employer-paid life and disability insurance with additional buy-up coverage options
- Tuition program
- Well-being benefits
- Full suite of benefits to support career development, individual & family health, and financial health
Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity
Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. - 2 Days Ago
Provider Network Management Director
- Elevance Health
-
Overland Park, KS
FULL_TIME
- Location: Topeka KS, Kansas City KSHours: M – F Standard Working HoursTravel: Hybrid (1-2 days onsite per week) In state travel to clients as neededPosition OverviewDevelops the provider network throu...
- 1 Day Ago
Director of Provider Network and Claims
- International SOS
-
San Antonio, TX
FULL_TIME
- Overall Purpose of the Role At International SOS we work to protect global workforces from health and security threats. We make a meaningful impact every day by safeguarding people and saving lives wo...
- 1 Day Ago
Provider Network Management Director
- The Elevance Health Companies, Inc.
-
TOPEKA, KS
FULL_TIME
- Anticipated End Date: 2024-06-21 Position Title: Provider Network Management Director Job Description: Location: Topeka KS, Kansas City KS Hours: M – F Standard Working Hours Travel: Hybrid (1-2 days ...
- 23 Days Ago
Director of Provider Network Development
- California Alliance of Child and Family Services
-
, CA
FULL_TIME
- Company Overview: Full Circle Health Network is an integrated network of nonprofit, nationally accredited providers delivering coordinated, community-based services to vulnerable children, individuals...
- 28 Days Ago
Director of Provider Communication
- Compass Health Network
-
Raymore, MO
FULL_TIME
- Compensation: The Director of Provider Communications role is to ensure Compass Health Network provider communication, strategic plans, and project operations run smoothly.Essential Functions include:...
- 4 Days Ago
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-
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-
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- CBRE
-
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- Advanced Drainage Systems
-
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- 6/7/2024 12:00:00 AM
Income Estimation for Provider Network Director jobs
$174,274 to $225,154