Position Purpose: Provide support for the management of physician, hospital and ancillary provider recruitment in accordance with corporate, health plan and state guidelines for assigned regions.
- Implement development activities for the recruitment and contracting of providers in provider networks in new and prospective markets
- Promote, maintain and manage team goals and objectives through effective hiring, performance management, coaching and career development
- Collaborate interdepartmentally for new and existing market expansions to ensure network operations deliverables are identified and completed as defined by the state Request for Proposals (RFPs) and/or state contract
- Manage and conduct effective contract negotiations and develop strategies, tactics and methods for specific network development initiatives
- Manage provider data management functions through a new RFP and/or state contract implementation with strategies that promote provider network
- Monitor operational and financial performance of contracts to guide future recruitment activities and future contract negotiations
- Develop a comprehensive provider network to meet or exceed contractual requirements
- Contribute to the development and use of provider marketing and training materials assuring compliance with all state, federal, and product guidelines in new and existing markets
- Contribute to the development of contract reimbursement methodologies, reimbursement allotment, and covered benefit grid to ensure contracts and fee schedules are performing optimally
- Ability to travel
Education/Experience: Bachelor’s degree in Health Administration, Business Administration, related field, or equivalent experience. 4+ years of provider recruitment, contracting, contract analysis, or provider relations experience. Must be knowledgeable of network development processes, contract language, principles of negotiation, credentialing and call center operations.