Our client, one of the nation's largest not-for-profit Medicare Advantage plans, has been dedicated to keeping Seniors both healthy and independent for many years. Their employees are passionate about helping Seniors, and understand that success is based on achieving the mission.
Responsible for the overall financial and regulatory performance of our client’s provider network. Develops and implements the strategic direction for the network and oversees network management operations to build and maintain a high performing provider network.
Defines long-term strategic goals for our client’s provider network and develops clear plans to achieve them.
Oversees operations that develop and maintain positive relationships and financially viable contracts with medical providers. Engages contracted network leaders and establishes and maintains positive business relationships. Negotiates contracts with high priority providers.
Collaborates with the Sales organization to execute company growth initiatives through the acquisition of new networks, providers, and vendors.
Accountable for provider performance related to financial, operations, regulatory, quality, and member satisfaction targets and other performance-related priorities. Ensures providers understand and commit to performance goals.
Leads key initiatives and collaborations that involve network partners.
Works across the organization, with clinical and administrative areas, to develop and deploy provider systems, standards, policies and procedures to improve network performance.
Oversees Network administrative functions, including budget management, internal and external audit, regulatory compliance, contract administration, and policy and procedure enforcement.
Collaborates with senior leaders to establish and achieve financial and membership growth targets. Contributes as a corporate leader by providing recommendations, direction and support of short and long-term company strategies.
Directs and supports staff to achieve organizational goals by communicating job expectations, planning, monitoring and appraising job results, coaching and counseling, driving increased employee engagement, and developing and maintaining succession plans.
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