Director Network Development- Mid Atlantic Region (Virginia, Pennsylvania or North Carolina state specific)

About the role

The Director Network Development oversees the development and management of insurance networks, focusing on improving affordability and quality outcomes while managing provider relationships and negotiation strategies. This role is crucial for building and maintaining a strong network of healthcare providers, ensuring access to care for members, and optimizing network performance.

Essential Duties And Responsibilities

• Manages contract negotiations with Major Health Systems and large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands
• Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations
• Proactively builds relationships that nurture provider partnerships to support the local market strategy
• Initiates, nurtures, and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing
• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position
• Identifies and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreements
• Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms
• Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities
• Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues
• Manages key provider relationships and is accountable for critical interface with providers and business staff
• Coaches and supports newer team members on strategies and approaches to successful negotiations
• Partners with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity

Qualifications

• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
• Experience with complex Hospital / Health Systems, Large Physician Groups and Ancillary provider contracting and negotiations
• Experience negotiating delegated credentialing agreements
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
• Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
• Team player with proven ability to develop strong working relationships within a fast-paced organization
• The ability to influence both sales and provider audiences through strong written and verbal communication skills
• Experience with formal presentations
• Customer centric and interpersonal skills are required