The Director of Network Relations will report to the VP of Network Management and will lead and execute an approach that supports a comprehensive network of business leaders and providers in the effort to support and strengthen Cardinal Innovation's mission. As a leader, the Director will develop and execute strategies that position Cardinal, its leadership and business favorably.
This person will be responsible for the development of departmental strategic plans that align with the department's overall business goals, anticipating challenges and future needs. As such, the ideal candidate for this role has proven, exceptional experience leading, collaboratively, cross-functional initiatives. The Director should have the capability to fluctuate between the three levels of a service model and ensure the model is executed with precision. Building a cohesive and fully engaged team is a necessity.
Responsibilities and Duties
- Oversee the end-to-end performance of provider network servicing, performance and data reporting.
- Monitor, identify and resolve technical, operational and organizational issues.
- Identify areas that warrant escalation and ensure timely resolutions.
- Work toward creating a strong infrastructure with a best practices control process.
- Adapt departmental plans and priorities to address business and operational challenges.
- Drive the design and implementation of programs that build / nurture positive relationships between the Managed Care Organization (MCO) and providers.
- Ensure implementation of training, ongoing mentoring and educational programs for external providers.
- Identify gaps in network composition and coverage services to assist network contracting and development team; provide cross-functional teams with findings.
- Oversee data quality reporting; monitoring key metrics to ensure performance expectations are being met.
- Directly manage a staff made up of Account Managers and Relationship Managers who play a part in managing the relationship of Cardinal's Top 15 providers.
- Indirectly manage relationships with a group of diverse internal departmental leads and external providers
Knowledge, Skills and Abilities
- An intermediate level of knowledge with claims/systems processes, contracting and reimbursement methodologies.
- Exceptional presentation, written and verbal communication skills.
- Demonstrated skills and experience in collaborative, strategic and analytical thinking.
- Proven experience uncovering obstacles and implementing an innovative troubleshooting approach.
- Strong interpersonal skills and demonstrated ability to take leadership simultaneous on multiple projects.
- Proven ability to manage large-scale projects in a fast-paced, deadline-driven, and highly collaborative environment.
- Expected to work well in a technically complex, constantly evolving environment.
- Display willingness to make timely decisions; exhibits sound, accurate and independent judgment.
Required Training and Education
- Bachelor's Degree and/or 10+ years of progressive healthcare experience including at least 5 years of Behavioral Health network management or related provider relations management. Advanced degree ideal.
- Proficient with MS Office suite (Word, Excel, PowerPoint).
- Advanced proficiency in Medicaid rules and regulations.
- At least 5 years of experience managing a staff of direct reports.
- Entrepreneurial spirit with a demonstrated ability to work collaboratively and influence others.
- Effectively communicate at all levels of the organization both internal and external.
- Experience in strategic positioning, developing, executing and adhering to business plans.
This is an office-based position which often requires long hours of sitting and working in front of a computer, utilizing computer technologies. This position will have some periodic travel to other Cardinal Innovations Healthcare sites within North Carolina for business meetings. Professional business attire is required.