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Compensation Disclaimer

Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations.

Department: Provider Network Development

FTE: 1.00; Full Time; Shift: Days

UNM Health provides the highest quality of care for more than 200,000 New Mexicans each year. In 1952, UNM Hospital was built on Native American grounds, with the promise to provide culturally competent and inclusive care to all New Mexicans. Since then, UNM Health has followed through with their mission of accessible, affordable care. UNM Health provided over $44 million in charitable care and financial assistance for services not covered by insurance or federal programs in 2018.UNM Health is New Mexico's only Level I Trauma Center—we care for patients with the most complex conditions from across the state. Additionally, we are the first NIH-designated Comprehensive Cancer Center and award-winning Advanced Care Stroke Center. UNM Health providers specialize in over 150 areas of medicine and employ over 7,000 professionals. Together, we receive 900,000 outpatient visits, 22,000 surgical cases and 100,000 emergency room visits each year.

Position Summary: This position is responsible for the strategic leadership, development and management of the provider network contracting and provider relations activities of the health plan. This role leads and participates in contract negotiations, network development, provider performance initiatives and provider engagement and training activities. Leads the development of an adequate, high quality, cost-effective provider network that supports UNM Health Insurance Plan (Plan) goals and priorities, meets or exceeds network adequacy and compliance standards. The Director will oversee provider contracting, network development, provider onboarding, provider education, issue resolution and provider performance initiatives. The position collaborates closely with executive leadership, medical management, claims, quality, and compliance teams to support organizational growth and provider and member satisfaction. Ensure adherence to Hospital and departmental policies and procedures. No patient care assignment.

Detailed responsibilities:

• CONTRACTING – Develops and execute provider contracting strategies that support the organization’s goals and financial targets
• NEGOTIATION – Leads negotiations with hospitals, medical groups, facilities, ancillary, behavioral health and long-term care providers
• CONTRACTING – Oversees contract implementation, amendments, renewals and terminations; serves as a key liaison between the Plan and the provider community
• COMPLIANCE – Ensures network adequacy is maintained in accordance with federal, state, and accreditation requirements
• PROJECT MANAGEMENT - Collaborates closely with Plan Senior Leadership, the Plan’s Third-Party Administrator and Hospital’s finance, legal, human resources, operations, quality and clinical teams as necessary
• PROCESS IMPROVEMENT - Facilitates resolution of complex provider disputes and issues
• STRATEGIC INITIATIVES - Collaborate with providers to improve operational efficiency, member experience and quality outcomes
• LEADERSHIP - Recruits, trains and mentors Provider Contracting and Relations team
• KNOWLEDGE - Evaluates market trends, competitor activity and provider landscape to inform policy and policy development
• COMMUNICATIONS - Develops and maintains strong relationships with contracted providers, Plan’s Third-Party Administrator and other identified healthcare organizations

Education:

• Essential:
• Bachelor's Degree
• Education specialization:
• Essential:
• Related Discipline

Experience:

• Essential:
• 5 years directly related experience
• Nonessential:

Credentials:

Physical Conditions:

• Light Work: Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. May require walking or standing to a significant degree or requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or may require working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of materials is negligible.

Working conditions:

• Essential:
• Minor Hazard - physical risks, dirt, dust, fumes, noise
• Tuberculosis testing is completed upon hire and additionally as required

Relocation Assistance Available