Director, Network Contracting
Health Choice is dedicated to improving the health and well-being of the people and communities we serve.
Health Choice believes in a personal approach to health care right in your community. We built our health care plan around you. Our goal is to give you quality health care, programs, and services to support you on your path to wellness.
Health Choice provides exceptional customer service and culturally competent care through:
- Compassionate and responsive member services team
- Collaboration with community physicians to help members get the health care they need.
- Providing culturally competent health care, including extensive translation and interpretation services
- Health programs to help members and their families stay healthy
Position Purpose: The Director of Network Contracting reports to Senior Director of Network Services. This position is responsible to provide strategic direction for and oversight of network development activities and works collaboratively to ensure compliance with all state and federal network requirements. Identifies provider needs with the Arizona network to meet the needs of members. Responsible to supervise, lead, direct and build a successful team.
- Oversees negotiation of provider and payor contracting activities
- Provides strategic direction for network development activities.
- Coordinates with other departments to ensure timely response to provider concerns and manage the relationships throughout the provider and payor community for all lines of business.
- Works with Medical Economics to monitor and maintain network adequacy and accessibility, market parity and relative deal strength.
- Oversees the development of provider contracts to ensure compliance with state and federal requirements.
- Oversees the maintenance of policies and procedures related to provider recruitment and contracting.
- Oversee Value Based Purchasing models, contracts and management.
- Establishes a provider recruitment plan for new business opportunities.
- Participates in responses to RFPs, specific to provider network services development.
- Monitors recruitment to ensure compliance with contractual network adequacy standards.
- Strategizes with other departments to ensure the provider network meets the health care needs of all plan members.
- Responsible for departmental staffing decisions and provides supervision to staff timely and appropriately.
- Other responsibilities as assigned.
Education / Experience / Other Requirements
- Bachelor’s degree in healthcare administration or commensurate managed healthcare experience
Years of Experience:
- Experience in leading Provider Relations and Network Development personnel required
- A minimum of three (3) years’ experience working in Medicaid, Medicare, and Commercial contracting desired
- Experience with AHCCCS contracting requirements
Specialized Knowledge, Skills & Abilities:
- Knowledge of provider contracting Skills:
- Computer experience necessary
- Effective time management skills
- Effective interpersonal and communication skills
- Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames
- Ability to manage large workload
- Ability to make appropriate independent decisions
- Ability to maintain positive work relationships
- Ability to supervise and lead and develop staff
- Ability to maintain a positive work environment for employees
- Ability to work cooperatively, positively, and collaboratively in an interdisciplinary team