Sr Dir, National Provider Contracting

United States

Job Description

The Sr Dir, National Provider Contracting initiates, negotiates, and executes National and multi-regional physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. Requires an in-depth understanding of how organization capabilities interrelate across the function or segment. Works on problems of diverse scope and complexity ranging from moderate to substantial. They will lead and manage the development of Magellan’s National and Multi-Regional provider contracting and operations enterprise wide. Will drive strategic initiatives within the provider network and ensure that the alignment of departmental objectives is congruent with
the overall business strategy. Primary responsibilities include:
  • Initiates and maintains productive long-term relationships with Hospitals and provider groups nationally.
  • Develops effective relationships with all Magellan functional areas to drive success in  National Network and Regional initiatives.
  • Provides  effective operations management, ensures that all contracts are within required guidelines and financial parameters, and maintains current provider data within payment systems.
  • Applies economic and strategic planning models to all endeavors in your region in order to align business, process, and operational principles with area-specific goals.
  • Communicates and develop internal and external C-Suite level relationships.
  • Communicates contract terms, payment structures, and reimbursement rates to providers.
  • Analyzes financial impact of contracts and terms.
  • Maintains contracts and documentation within a tracking system.
  • Assists with identifying and recruiting providers based on network composition and needs.
  • Advises executives to develop functional strategies (often segment specific) on matters of significance.
  • Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.               
  • Provides expert consultation in organizational contracting methodologies and reimbursement methodologies, reimbursement coding, and network configurations and analysis for provider databases to internal, vendor and customer claims systems.
  • Establishes internal and external department communications. 
  • Submits monthly reports timely, meets projects deadlines, and provides timely follow-up to internal and external customers.
  • Monitors and reports key metrics of department performance for productivity and quality, as appropriate.
  • Prepares and oversees National Contracting departmental budget.
  • Establishes productivity (reasonable expectations for performance and turnaround times) and quality standards and tools to measure functional and workflow outcomes for new program implementations with respect to provider activities.
  • Maintains and meets productivity and performance standards for all activities for successful program execution.
  • Assures the establishment and application of a systematic model for the preparation of network administration, privileging and provider loads.
  • Evaluates productivity and performance reports and data for the purposes of reporting, providing employee feedback and determining changes necessary to improve performance.
  • Ensures process changes are developed when necessary, training is provided, processes are implemented and results support department success.


 

General Job Information

Title

Sr Dir, National Provider Contracting

Grade

31

Job Family

Operations Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

1/25/2019

Date Requisition Created

1/24/2019

Minimum Qualifications

Education

Bachelors (Required), Masters

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Understanding of health delivery systems.
  • Knowledge of managed health care, health care trends, including reimbursement and coding and network management/administration.
  • 15 years experience in healthcare and/or business experience with direct National and Multi-regional provider contracting experience in a production environment.
  • At least 10 of previous management, project management, or on the job equivalent experience required.

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