Director, Provider Network Strategy & Partnerships

Superior Dental Care, Inc.; Olde West Chester (OH); On-site; USD 140,000 - 190,000; Full time

Benefits offered by this job

On-site work at Brooklyn, Dublin, or W

West Chester OH offices

Job summary

Medical Mutual is seeking a Director, Provider Network Management to oversee relationships with physician, professional, institutional and ancillary providers. The role includes contract negotiation, reimbursement strategies and achieving cost, access and quality targets across all lines of business in Ohio.

The position requires extensive experience in provider network development and managed care, plus strong leadership and analytical capabilities.

Qualifications

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or related field.
• Master's degree in Business Administration (MBA) or Health Care Administration (MHA) preferred.
• 8 years progressive experience in provider network development, managed care, or equivalent, 5 years of which are in a managerial or leadership capacity.
• Experience in establishing and maintaining provider networks for specific products including commercial and government programs.

Responsibilities

• Reviews proposed contracts and manages multiple concurrent negotiation processes to achieve annual local and regional network targets related to cost, access, methodology, language and quality across all lines of business.
• Establishes and maintains strong, collaborative relationships with high volume/complex providers and health systems including institutional, professional and ancillary provider networks across all product offerings.
• Directs assigned operations and staff including provider access; improving quality and clinic outcomes; provider satisfaction and education; and staff resources, performance management and learning and development.
• Partners with Sales, Clinical, Network Informatics and other areas to achieve Customer satisfaction goals and support provider partnerships.
• Collaborates with internal resources and external providers and others to support departmental and company projects and initiatives as well as corporate participation in governmental and/or specialty products as they are developed.
• Participates in the preparation of documentation to ensure regulatory compliance and the networks achieves and maintains applicable accreditation standards.
• Performs other duties as assigned.

Skills

Analytical skills

Interpersonal skills

Microsoft Office

Provider network development

Contracting knowledge

Education

Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or related field

Master's degree in Business Administration (MBA) or Health Care Administration (MHA) preferred

Job description

Medical Mutual is seeking a Director, Provider Network Management to oversee relationships with physician, professional, institutional and ancillary providers. The role includes contract negotiation, reimbursement strategies and achieving cost, access and quality targets across all lines of business in Ohio.

The position requires extensive experience in provider network development and managed care, plus strong leadership and analytical capabilities.