Job DescriptionThis position is responsible for the strategic and tactical direction and oversight for division network management related to developing and maintaining a comprehensive delivery system nationwide. This role is responsible for leading staff in developing and implementing a national and regional plan that meets the customer requirements within budget plan and assures access to a network of services that supports member access and cost of care plans. The position will have direct management responsibility of network staff supporting division business unit and will establish requirements for support of this business segment which will be executed by other individuals within and outside of the network department. This role will include working with the SBU in new business development opportunities throughout the division and implementation of new programs. The position will provide thought leadership to all aspects of the network department's support of division business.
•Establishes overall direction, plan and working processes for network teams in support of division.
•Oversees and provides network thought leadership to existing commercial programs including recommendations for enhancements to existing provider network programs, contracting approaches, funding arrangements, provider relations activities, etc.
•Manages financial goals (e.g., control care cost trends, profitability) as defined by the business operations and the network SVP, including assuring that the network is cost effective, marketable, stable and offers appropriate access and Care Management Centers (CMCs) meet cost of care plan.
•In conjunction with network SVP, 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, facility and organizations) recruitment activities.
•Provides supervision, development and mentoring of the commercial field network management teams in meeting objectives and functions.
•Supports business development activities as they relate to or interface with the provider community, during the pre procurement period, the RFP process, and the business implementations process.
•Directs network reimbursement and negotiation strategies in conjunction with the divisional team to assure the division is within cost of care plan.
•Establishes programs to develop and maintain positive relationships between provider constituents and stakeholders, and to influence and change behavior of providers in accordance with business operations goals and objectives.
•Develops and maintains positive and effective working relationships across the Magellan organization and in particular with the SBU and network department.
•Develops strategic and tactical direction for network expansion activities in support of Medicare/Medicaid strategies.
General Job Information
TitleSr Dir, Regional Field Network Management
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date2/25/2019
Date Requisition Created2/18/2019
EducationBachelors (Required), Masters
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
10 years experience in healthcare and/or business experience with direct provider credentialing, and/or contracting experience in a production environment. At least 8 of previous management, project management, or on the job equivalent experience required.Understanding of health delivery systems. Knowledge of managed health care, health care trends, including reimbursement and coding and network management/administration.
Understanding of health delivery systems. Knowledge of managed health care, health care trends, including reimbursement and coding and network management/administration.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled