Job Description

Position Purpose:  This position is directly responsible for the development, adequacy, implementation and management of Physician, Hospital, and Ancillary network providers.  This position oversees and is responsible to provide education, training, and management to achieve established goals within their assigned Chapter(s), including network adequacy, achieving membership growth targets, meeting financial parameters for medical expenses, and financial performance within the Chapter.  Frequent travel to Provider offices is required.  This position requires initiative and assertiveness when dealing with Chapter goals and performance.  Sound and objective decision making must be exercised in all interactions with providers, payer partners, and internal departments.  This position also leads Network initiatives such as provider education for new payer implementation.   

    

Ensure that network providers satisfy financial goals within the assigned Chapter.  Develop provider strategies including, but not limited to: Participating in and leading Chapter meetings, Develop and communicate strategic initiatives to strengthen the financial position of the assigned Chapter(s), Perform in-service/education to providers, Ensure providers are following proper medical procedure and referral, information/authorization, covered service guidelines, and submission of claims, Utilize reporting, including developing new reports and available data to facilitate data sharing and improve performance within the Chapter. 

 

Leads Chapter meetings and facilitates impromptu meetings as required, Develops strong relationships with hospital leadership as well as provider groups, Provides orientation to new providers within 30 days of contract execution, Providers understand and actively work to maximize contract opportunities, Responds to requests for research and resolution to complaints, Communications and items disseminated are complete and accurate.

 

Communicates regularly through various communication methodologies, including one on one or group meetings, with local providers and their staff consistent with the key messages disseminated from the SHCN Governance Structure at the direction of the SHCN Leadership Team.  Develops and provides education to provider and office staff regarding initiatives of the local chapter and SHCN including health plan updates.

 

Develop, monitor, administer, maintain, and manage the physician, hospital, and ancillary provider network within all PODs: Analyze and evaluate network coverage to identify network needs, Understand and explain contract opportunities to providers. 

 

Network coverage is analyzed and evaluated to ensure network adequacy, Service gaps are identified and a strategy is developed and implemented to cover such gaps.

 

Has knowledge on all PCPs and Specialists within assigned Chapter, including key information such as group membership, affiliations, and historically contextual elements.

 

Develop and implement provider education campaigns around new payers other initiatives: Analyze and evaluate provider education needs, including reporting and provider tool-kit materials.

 

Consistent and concise messaging to the provider network, new payer contract documents are delivered and processed efficiently within required timelines.  Ability to convey information about the Steward Health Care Network and the Steward system to leave candidates with a positive impression about the organization.  Consistent and concise messaging to the provider network, New payer contract documents are delivered and processed efficiently within required timelines.

 

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

Qualifications

Education:   

·         Bachelor’s degree preferred

 

Work Related Experience:

·         Minimum five (5) years experience in healthcare environment

·         Minimum of one (1) year contract negotiation experience preferred

·         Excellent verbal and written communication skills

 

Specialized Knowledge:  

·         Strong analytic skills and the ability to identify opportunities for performance improvement and translate into action plans.

·         Strong communication and relationship skills required. Knowledge of methods used for improving performance/motivation.

·         Ability to generate creative solutions, identify the best course of action and rapidly resolve complex issues/problems.

·         Ability to communicate clearly with both internal and external customers at all organizational levels, and across differing cultural backgrounds

Application Instructions

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