Director Provider Network Development Jobs in Virginia

Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Dominion National at the time of posting and may be modified in the future. Dominion National offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

Dominion National, a rapidly growing and leading provider of dental and vision benefits, has an exciting opportunity for an experienced Director of Network Development.

The Director of Network Development is responsible for the direct expansion, maintenance and quality of the organization's dental provider network activities. The Director ensures provider relations program's policies, procedures and regulations meet the needs of Dominion National and its members, as well as state and federal requirements. The Director works with the Senior Team, Colleagues and Staff to develop the Annual Network Development Plan and is also responsible for the execution and success of the Plan.

• Effectively lead and manage recruitment and administration team.
• Develop recruitment plan with leadership and sales to target and prioritize recruitment areas including expansion opportunities.
• Direct Provider Development Managers and staff to meet targeted recruitment goals.
• Act as liaison between Network Development and various Dominion administrative departments.
• Responsible for provider compliance with state and federal regulations.
• Oversees complaint processes and procedures.
• Maintain current knowledge of industry and technical issues through participation in seminars, workshops and publications.
• Identify and recruit providers as necessary to ensure the development of a provider network compliant with CMS network adequacy and other entity requirements.
• Coordinate with Actuarial, Finance and the Senior Team the review and development of provider fee schedules that will help ensure the growth of Dominion National's provider network.
• Ensure provider demographic and rate related information is captured and properly loaded in all Dominion systems consistent with company policy
• Recruit, manage/oversee the training of new employees, as well as developing and applying appropriate policies and procedures for Network Development activities, including compliance.
• Direct the ongoing operations of the Provider Network, including the development of reports to measure the overall functioning of the department to ensure adherence to all performance metrics.
• Participate in the evaluation, recruitment, and management of vendors for specialized services.
• Participate and represent department in cross-functional standing committees as requested.
• Monitor daily performance of staff to ensure adherence to all performance metrics and promptly identify necessary corrective actions.
• Build strong relationships with providers.
• Performs other duties as assigned.

Skills:

• The minimum qualifications listed below are representative of the knowledge, skill, and ability necessary for an individual to perform each essential function satisfactorily.
• Understanding of and relevant experience in commercial and Medicare populations and lines of business.
• Proven effective communications skills (verbal, written, presentation) with all types and levels of audiences.
• Proficiency with MS Office applications (word processing and database/spreadsheet)..
• Excellent analytic, interpersonal, project management, negotiation and leadership skills.
• Critical thinking, problem-solving and collaborative team-player mindset.
• Confidence in taking ownership of work processes with only high-level direction and guidance;
• Ability to lead people and inspire them to do their best.

Knowledge:

• Knowledge of reimbursement principles and state and federal Medicare/Medicaid financing rules and regulations.

Experience:

• Minimum 7 years of dentist recruitment focused in the Group Health/Dental fields necessary.
• Minimum 3 years of leadership experience at a health plan.
• Proven ability to effectively manage in a matrix organization.
• Previous experience with implementation and expansion of a health plan business unit or division.

Education and Certifications:

• Bachelor's degree in business administration or a related field or in lieu of bachelor's degree 10 years of dentist recruitment focused in Group Health/Dental fields.

Physical Demands:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• While performing the duties of this job, the employee is regularly required to talk or hear.
• The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.