* Please note that the accompanying Candidate Interview Questions must be completed in order to be considered for the role *
Our client is a Healthcare industry leader in Managed Care and Healthcare Services. We are seeking an experienced Healthcare Network Development & Contracting Director in the St. Louis, MO metro area for one of its health plans.
The Healthcare Network Development & Contracting Director leads the functions of network development, provider contracting and/or provider relations. The position is responsible conducting and supporting decision-makers with analysis related to access, reimbursement and unit cost management. The role aids in formulating and administering organizational policies and procedures. The ideal candidate has network development and contract experience with a large health plan and prior leadership experience.
PRIMARY RESPONSIBILITIES INCLUDE:
CONTRACTING AND NETWORK DEVELOPMENT
Oversee provider contracting activities of the Contracting department to ensure efficiency and maintain compliance with the business unit’s policies and standards, government laws and regulations.
Oversee network development and contracting staff and external consultants in the development of health care provider networks for new and expansion markets.
Implement recruitment and contracting development activities for provider networks in new, prospective and existing markets.
Support new business launches in diverse markets while considering individual market circumstances, provider community, budgeting constraints and available resources
Provide leadership, inspiration and development opportunities to Network Development and Contracting team members. Coach and manage performance for maximum effectiveness.
ANALYSIS, DATA & COMPLIANCE
Analyze and interpret data and analytics in the evaluation of prospective large contracting deals.
Perform complex financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives. Evaluate opportunities to expand or change the network to meet Company goals.
Monitor performance, develop, and implement business solutions to address process and quality gaps, and communicate network strategy and planning.
Ensure provider compliance with all applicable Healthcare and Government requirements, accessibility and accommodations. Educate providers on compliance requirements and maintain compliance.
KEY RELATIONSHIPS / STAKEHOLDERS:
Head of Operations
Health Plan CEO and Leadership Team Members
Internal Network Development and Contracting Team Members
External Vendor Partners
Leads Network Development and Contracting for the Health Plan. Collaborates with internal leaders and external vendor partners. Leads, mentors and develops team members at various levels.
Office-based role in St. Louis, MO metro area. Candidate must be able to travel for required company meetings.
RELOCATION ELIGIBILITY: Yes, national relocation available.
TRAVEL REQUIREMENTS: Travel to company, conference and vendor meetings, including periodic overnight and weekend travel as required up to 20%. Must have a valid driver’s license.
POSITION REQUIREMENTS INCLUDE:
Bachelors degree in Business Administration, Healthcare Administration or related field or equivalent combination of education and work experience. MBA or MHA degree desirable.
10+ years of combined experience in healthcare network development, contracting management and provider relations in a healthcare or managed care environment. Prior Medicare and/or Medicaid experience preferred.
Strong knowledge of national health care laws and regulations.
Demonstrated project management skills and the ability to effectively prioritize and manage multiple projects and initiatives.
Strong communication, interpersonal, collaboration, influencing, consensus-building and negotiation skills.
Strong presentation, Powerpoint and Excel skills.
Prior team management experience with the demonstrated ability to lead and develop team members. Prior experience with hiring, training, assigning work and managing staff performance.
Demonstrated ability to analyze and interpret data and analytics in the evaluation of prospective contracting deals valued at more than $1M.
Additional competencies: Flexible, Self-Motivated, Adaptable, Action Oriented, Team Player and Drive for Results.
Must be able to travel, as required, and have a valid driver’s license.
Legal authorization to work in the U.S. is required. Company will not sponsor individuals for employment visas, now or in the future, for this job.
COMPENSATION & BENEFITS INFORMATION:
Target base salary range: Competitive and commensurate with experience and qualifications.
Variable Pay: 20% annual bonus incentive.
Benefits: Excellent benefits package which includes Medical, Dental, Vision, 401K with company match, Employee Stock Purchase Plan, Life, AD&D, STD <D Insurance, Tuition Reimbursement, paid time off, on-site fitness centers, partner product discounts, etc.
Visit us at: www.TalentSolutionPartners.com
Talent Solution PartnersTalent Solution Partners is a full-service Talent Acquisition and Solutions Firm. Our primary focus is the placement of senior-level professionals and executives for clients in Consumer Products, Healthcare,,Consumer Products, Business-to-Business Services and related industries. Visit us at: www.TalentSolutionPartners.com
Saint Louis, MO