Position Purpose: The Regional Network Director develops provider network strategies; negotiates, implements and maintains provider networks that consists of multiple or complex provider contracts in the region. Manages the activities of regional provider staff responsible for servicing the network, consistent with company goals, policies and objectives. Directs and manages networks (market, state or national based) and works on corporate projects. Ensures that Health Net is in compliance with federal, state and regulatory requirements.
- Develops goals, work plans and schedules for regional provider staff and ensures that they are executed. Responsible for the day-to-day supervision and monitoring of contracting staff and negotiations, provider services administration and operation for local region, statewide and/or national providers. Responsible and held accountable that overall region/statewide/national provider databases are maintained current and accurate, and information is presented internally and externally in a timely and professional manner.
- Plans and coordinates the addition of health care providers within an assigned geographical area; leads the negotiations of annual contracts within the region or statewide; monitors the performance of providers, and within accepted Health Net practices, has authority to finalize and close contract negotiations. Responsible for accurate and timely data analysis, presentations and provider education.
- Monitors capacity of existing medical groups, negotiates for additional capacity or explores other alternatives. Determines which groups need assistance in managing Health Net programs, and assists them in developing corrective action plans. Responsible for accurate analysis and assessments of quality of care and access by patients.
- Facilitates and assists with problem resolution related to numerous entities including, but not limited to, providers, marketing, claims, member relations and employer groups.
- Ensures that staff is adequately trained in all skills necessary and appropriate to their job, including but not limited to the following areas: contract negotiation and/or interpretation and clarification, marketing programs, Health Net products, customer service, provider network management and project management.
- Provides leadership and direction to corporate and statewide projects, and ongoing regional responsibilities.
- Coordinates with Sales and Marketing on programs for region and/or statewide providers. Working with Legal on issues.
- Consults with Organizational Effectiveness on human resources related issues for the region, including but not limited to selection, conflict resolution, staff development, and performance evaluations.
- Significant budgetresponsibilities and impacts. Monitoring and meeting budgetary goals on a regular basis.
Education/Experience: Bachelor’s degree in Health Services, Health Care/Hospital Administration required, or related field or equivalent health care experience; Master’s degree preferred.
Five to seven years extensive provider network management/health care management experience, of which four to six years of progressive network contract negotiation experience.
Strong project management experience plus previous supervisory/management experience required.