Leads the market's strategy and planning in the successful development of the provider network, including development, contracting and management of provider relationships and communications. Manages a team of employees who develop, negotiate, contract and enhance provider networks that are high quality, cost efficient and improve the lives of our members. Develops the network, assuring network adequacy and access to member choice in compliance with federal and state laws. Negotiates and services larger and more complex market/national/group-based providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and affordability initiatives. Responsibilities and complexities may vary by market and may be organized by services, such as hospitals, providers; or type of contract, such as fee for service or value-based contracting.

• Leads the market's strategy and planning in the successful development of the provider network including development, contracting and management of provider relationships and communications.


• Plans, develops and implements a geographically competitive, broad access network that meets objectives for unit cost performance and trend management.


• Implements actions to build out network expansion markets and/or to close gaps.


• Meets with key providers to ensure service levels are meeting or exceeding expectations.


• Evaluates, negotiates and supports larger and more complex market/national/group-based providers in compliance with company standards while meeting and exceeding accessibility, quality, financial goals and cost initiatives.


• Leads and manages a high performing team who develop, negotiate, contract and enhance collaborative provider relationships, ensuring overall network competitiveness and profitability within market.


• Advances company's strategy to adopt value-based payment models; may oversee the implementation and management of value-based arrangements.


• Recruits and ensures provider network includes an appropriate mix of provider specialties to meet the needs and growth of membership.


• Collaborates with operations to monitor and ensure service issues are resolved, including escalated claims payments/disputes, provider demographics, provider contracting accuracy and credentialing.

Other Job Requirements

Responsibilities

5+ years in a Provider Relations role for a managed care plan.
Solid knowledge of health plan operations required. Depending on assigned business unit, knowledge or experience in management of medical drug benefits, specialty pharmacy, pharmacy benefits management (PBM), behavioral health, or radiology may be required.

General Job Information

Title
Dir, Network Development, Health Plans

Grade
30

Work Experience
Network

Education
Bachelors (Required), Masters: Business Administration

License and Certifications - Required

License and Certifications - Preferred

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.