Director Of Managed Care And Network Development

NaphCare is accepting applications for a Director of Managed Care and Network Development at our corporate headquarters located in Birmingham AL. The Director of Managed Care and Network Development is responsible for managed care contract management including coordinating, evaluating, and overseeing the implementation of off-site managed care contracting and related responsibilities, value-based contracting initiatives, and government payer regulations. Responsible for developing new and existing relationships with off-site community providers to ensure competitive rates and contract language aligned with government contract terms and state and federal statutes related to inpatient stays. Lead all aspects of provider network strategy including access analysis, network operations, and analysis related to payment and cost management.

Responsibilities:

• Develop relationships with community hospitals and providers.

• Evaluate, negotiate, and secure financially and administratively favorable contracts with new and existing community providers.

• Develop and support managed care strategies and initiatives to adapt to ongoing healthcare payment reforms and evolving payment methodologies.

• Function as an effective liaison between the organization and collaborative partners.

• Develop and foster effective collaboration between clinical departments, divisions, medical staff leadership, and other affiliated services to ensure an integrated approach to providing services and fulfilling the organization's clinical and educational goals and objectives.

• Participate in activities that result in improved contract performance, which include performing payment analysis and responding to community provider concerns and questions.

• Serve as a resource to help reduce cost, achieve effective utilization and quality goals and objectives, and utilize information to develop and support management decisions.

• Communicate key information to the stakeholders of these service areas

• Expand referral networks to ensure effective partnerships are formed

• Oversee network development staff in the development of provider networks across expansion markets.

• Perform periodic analyses of the provider network from a cost, coverage, and growth perspective.

• Provide leadership in evaluating opportunities to expand or change the network to meet Company goals.

• Manage budgeting and forecasting initiatives for product lines to network costs and provider contracts.

• Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.

• Conduct periodic reviews of provider contracting rates to ensure strategic focus is on target with overall Company strategy.

• Ability to travel.

Qualifications:

• Master's Degree preferred and a minimum of 5 years of experience in responsible healthcare operations or finance at the administrative leadership level.

• Demonstrated leadership and complex organizational management skills.

• An understanding of how to achieve results in a healthcare environment.

• Well-developed planning, organizational development, and business skills.

• Experience in health care administration in a complex setting.

Equal Opportunity Employer: disability/veteran