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Organization TypePublic Interest
Years of Experience
Date Last Verified
ProfileSenior Director, Contracting and Provider Networks The candidate will be responsible to develop a Contracting Strategy on an as needed basis for the various targeted markets. Develop the key metrics to ensure a high level of network adequacy. Responsible for robust competitor and provider competitive analysis and the creation of other information to formulate a business decision related to the provider network. Compile quarterly and annual statistic. Responsible for the effective integration of new providers into the Provider Operations infrastructure. Ensure that the provider setup for new markets or regions is consistent with the Departmental standards. Provide oversight of provider contracting activities when completed by contractors or other individuals or entities working on behalf of the Health Plan. Responsible for aggressive recruitment programs including recruitment materials and development and facilitation of quarterly reports . Provide formal feedback, documentation and resolution of areas for improvement and monitor sustained improvement. Review audits of all performance from a productivity, performance and quality perspective; address issues as identified. Implement a process in conjunction with other departmental Management to ensure an effective approach to on-boarding new providers. Ensure the network complies with all regulatory requirements as well as with all company-mandated policies and procedures. Ensure provider network is adequate, cost effective, competitive, stable and meets the corporate and regulatory access requirements. Interact with the Finance Department in terms of pricing for provider contracts. Participate in training sessions for providers and staff as appropriate. Perform any other job related instruction as requested, with reasonable accommodation.
Qualification and Experience
The candidate should have Bachelor's Degree in Business Administration, Health Care Administration or related field; A Master's Degree and or Juris Doctor is preferred. Must have 5+ years of health law, contracting and network development/ management experience in a managed care setting at a senior management level. should have strong negotiation skills with caommunicate effectively, verbal and written.
Job ID: 2018-11466
205 Lexington Avenue, 3rd Fl
New York City, NY 10016