Director, Network Development

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities.

Job Description Summary:

JOB SUMMARY

This role is responsible for leading network development of Health Plan Provider Networks. Leads the development of network growth, contracting and provider relations support. This position interfaces with all functional areas to ensure support of both Health Plan financial objectives and effective provider reimbursement and management . Success in this role will also be determined by the ability to communicate the vision for a competitive and innovative network and product integration while developing the plans outcomes-based network development strategy, considering the evolving competitive marketplace and provider landscape. This role will report to the COO, Sr. Director of the Medical Plan.

Minimum Qualifications:

Bachelor's Degree (Required)

SPECIALIZED KNOWLEDGE

• Ability to successfully negotiate provider agreements to meet Health Plan goals and objectives.

• Experience with different provider payment/reimbursement methodologies.

• Experience in the development of distinct types of provider networks, such as narrow networks, tiered networks and/or clinically integrated networks.

• Knowledge of provider network adequacy requirements for Medicare Advantage and/or Department of Insurance network requirements for commercial Health Plans and Medicaid Managed Care Plans.

• Knowledge of NCQA accreditation standards for provider network management.

• Knowledge of provider network referral/authorization processes, and knowledge of provider network credentialing process and policies.

• Ability to effectively lead, coach and develop team members.

• Ability to foster teamwork and work effectively in a cross-functional team environment.

• Advanced organizational, planning, analytical and critical thinking skills.

• Ability to solve practical problems and deal with moving variables in situations with limited standardization and alignment.

• Ability to read, analyze, and interpret technical procedures, contracts, or governmental regulations.

• Ability to write provider agreements, amendments, and reports.

• Ability to effectively present information and respond to questions both internally (within the Health Plan) and externally, with groups of managers, clients, customers, and the general public.

• Computer skill, expertise, and experience with MicroSoft Word, Excel, Powerpoint, and data bases

Work Shift:

Day

Scheduled Weekly Hours :

40

Department

Product and Network Development

Join us!

... if your passion is to work in a caring environment

... if you believe that learning is a life-long process

... if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment