Director, Network Management

Orlando FL 32819

Job Description

Responsible for the strategic and tactical direction of all activities for an assigned region(s) related to developing and maintaining the physician, practitioner, facility and organization services delivery system. Position is responsible for developing and implementing a plan that meets the customer requirements within budget. Assures access to a network of services that supports member access and that Health Plans are within cost of care plans.

Essential Functions


- Establishes overall direction and plan and working processes between Network Management and Network Administration staff, including credentialing, communication (provider services line, letters, website, etc), database integrity and maintenance, regular reports, and rate loading.

- In conjunction with Network leadership and Health Plan, develops and implements a Network strategy to assure long term mutually successful physician, practitioner and facility and organization provider relationships. Directs all provider (physician, practitioner and organizations) recruitment activities.

- Provides supervision, development and mentoring of the Field Network Management Department in meeting objectives and functions.

- Manage financial goals (e.g., control care cost trends, profitability) as defined by the business operations, network and health plan senior management team, including assuring that the network is cost effective, marketable, stable and offers appropriate access and Health Plan meet cost of care plan.

- Directs network reimbursement and negotiation strategies in conjunction with business operating unit senior management team to assure HP is within cost of care plan.

- Establishes programs to develop and maintain positive relationships between MCC and providers, and to influence and change behavior of providers in accordance with business operations goals and objectives.

General Job Information

Title

Director, Network Management

Grade

29

Job Family

Operations Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

11/19/2018

Date Requisition Created

11/19/2018

Minimum Qualifications

Education

Bachelors (Required), Masters

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

- 5 years of progressively more responsible health care administration experience (finance/contract administration, physician/provider relations) with strong preference for managed care experience.- 3 years experience in a leadership role.- Broad-scoped financial expertise, with financial modeling experience.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled