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Director, Network Management
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Summary: Contribute to and execute the Network Strategy through contracting, management and enablement engagements with the goal of developing industry leading innovative, collaborative partnerships to ensure geographic coverage, and access to high quality, cost efficient providers within all regulatory and compliance requirements. Develop and improve market competitive positioning. Manage, mentor, train, educate and engage contracting and network management staff to drive results as called for in formalized plan objectives. Cross segment/department collaborations drive flexible and innovative solutions to reach the triple aim on cost, quality and customer satisfaction outcomes.
- Supports and drives execution for new innovative Network Strategy deployment including but not limited to the development of alternative payment models, unit cost targets, Quality improvement, and delivery system partner integration.
- Forecast and manages unit cost performance to targeted levels of improvement to hit competitive advantage for market. Maintains stability of ConnectiCare provider network.
- Oversight and drives designated contracting efforts for Key delivery system partnerships including health systems, hospital, physician, and ancillary providers in conjunction with Network Strategy inclusive of reimbursement methods, pay for performance, provider collaboration agreements, network “tiering”, and ACO and PCMH type arrangements.
- Drives planned results with Provider Collaboration groups through cross-functional teams including Medical Operations, Analytics and Operations teams.
- Cultivates relationships with key provider group practices and hospitals as contracts for agreements are negotiated and implemented.
- Manages, mentors and motivates Network Management team members.
- Manages multiple contract healthcare delivery networks and achieves competitive cost position for assigned portfolio. Tracks, trends and reports on impact of network contracting efforts based on risk sharing, alternative payment arrangements, and traditional unit cost. Adjusts as needed to achieve budgetary requirements.
- Leads contract remediation efforts and drives contract compliance process. Updates contract language to include regulatory compliance changes and assure in compliance with standards.
- Leads cross departmental discussions to facilitate changes as needed to manage current environmental issues.
- Verifies contracts are submitted within established standards for lead time, contract provisions and reimbursement methodologies.
- Assures compliance with regulatory agencies, including but not limited to CMS, NCQA, and HEDIS.
- Works in collaboration with Analytics and reporting to assure bidirectional information sharing to provider collaboration for managing to contract terms and successful improvements in outcomes.
- Oversees and manages to network access standards as well as drive network management levels based on service coverage and quality measures.
- Performs other related projects and duties as assigned.
- Bachelor’s Degree required, Master’s Degree in Business or Healthcare strongly preferred.
- Minimum of 10 years’ experience in healthcare mid to senior level management experience in contracting, medical management, provider relations, or finance area required.
- Previous experience in an IPA plan management or like role for health insurer required
- Proven leader with accomplishments in negotiations and management of risk based healthcare contracts.
- Strong understanding of healthcare reimbursement methodologies from operational and functional as well as financial perspective.
- Ability to drive change management to achieve innovative solutions as industry leader.
- Ability to function productively in multidisciplinary environment, cross divisional team building to achieve horizontal integration. Mentor and develop contracting strength within internal team.
- Excellent analytic, problem solving, communication skills (both written and verbal) a must.
- Competitive intelligence to drive and create market contracting plans supportive of Network Strategy.
- Working knowledge of personal computers to include basic work, excel, power-point.
- Able to travel with in a defined geographic area.
- Assure regulatory compliance is maintained through contract negotiations.
Essential Job Functions:
- Requires travel 40% of the time using own transportation
- Primarily sedentary
- Must be able to use standard office equipment
ConnectiCare is an equal opportunity employer. M/F/D/V
ConnectiCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.