Director, Network Development Position Available In Miami-Dade, Florida

Back to Career Site We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all. We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

JOB SUMMARY

The Network Delivery Development team is responsible for partnering with our Care Partners including all other Network relationships to turn their provider networks into market leading and high performing integrated delivery systems. We are reimagining how the network development, network management, and provider relations functions can advance affordable, simple, and personal care for our members. The Director, Network Development will be a leader on our team and will act as a thought leader for the entire organization with specific National responsibilities as assigned including leading our National Ancillary Negotiations and designated Employees. This position will play an integral role in driving the company’s performance by building, optimizing, and transforming our insurance networks. This position will be responsible for supporting NeueHeath’s relationship development with key National network participants as designated across their designated Regions of NeueHealth’s insurance networks as well as for advancing reimbursement best practices alongside our Care Partners.

DUTIES & RESPONSIBILITIES

The following job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Develops, organizes and executes National Network Strategy for Targeted National Ancillaries, National & Regional Hospital Based Physicians and other National Medical Groups to improve affordability and quality outcomes.

Ensure coordination and alignment of National Providers with each market to drive Best in Class Pricing and Quality of Care improvement programs, including contracting criteria for local Ancillary Providers.

• Develop and maintain Outpatient Reference Lab strategy to include support of current Policy and Policy development to reduce non-par Lab Leakage, eliminate unnecessary Lab testing, physician office lab testing, genetic testing, Market Lab contracting Strategies, enforcement of clinical data service agreements with Reference Labs for HEDIS Reporting and other initiatives to maximize company performance.

• Solicits Annual Market Purchase Order Network Requisition Needs for each Market.

Aligns & coordinates with Market Leaders and Regional Network Managers on Annual Market Network Strategy for each NeueHealth Live Market. Market Network Strategy will include LOB Target Assessment, Project Planning for any geographic and/or Product Market expansion, and other Network Needs as Prioritized by the Market Leaders.

• Organizes National Network Strategy for Non-Par utilization via coordination with Smart Networks to align Priorities and Target action plans with Regional Network Managers for each Market. As assigned, engage on Targeted Provider negotiations to improve on NeueHealth affordability and quality outcomes.
• Coordinates and Develops with Smart Networks, tailored Network Reimbursement Guidelines including Preferred and Acceptable Reimbursement methodology adherence and establishing reimbursement schedules for each Market, documented in Market Contracting Guidelines.
• Develop Network Management Training Programs including Network Development functional leader for Contract Management System Training with coordination within Operations to ensure accuracy and administration of Provider Data.
• Assist as requested in negotiations with Care Partners and other sophisticated provider entities as assigned or as identified.

Prepares written status updates for key stakeholder reviews and aligns other network opportunities to ensure Market initiatives are met.

EDUCATION AND PROFESSIONAL EXPERIENCE

• A Bachelor’s Degree in business, economics, healthcare administration, or a related field is required; extensive relevant experience will be considered in lieu of a degree. Master’s Degree Preferred
• Ten (10) years of experience, with at least seven (7) years of experience in network development, network management, or reimbursement model design required.
• Five (5) years prior management experience strongly preferred.
• Experience with successfully executing and implementing payer-provider contracts or partnerships required for Commercial, Medicare and Medicaid lines of business including significant experience with Value Based Incentive Risk and/or Shared Savings network contracting models.
• Proven experience with developing, presenting and analyzing various types of financial analyses, contracting models and network engagement in order to make informed strategic decisions required.

PROFESSIONAL COMPETENCIES

• Desire and ability to move quickly between strategic leadership, tactical execution, and managing analytics
• Knowledge of managed care practices and procedures, specifically in contracting language and negotiations. Provider relations is preferred
• Ability to effectively engage providers, ranging from national providers to regional integrated delivery systems to local physician practices
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures
• Excellent multitasking and prioritization skills with a proven ability to manage multiple projects in parallel to completion
• Superb written and verbal communication skills with an ability to effectively collaborate with internal and external executive leadership As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.