Director, Contracting & Network Management
Job Title: Director, Contracting & Network Management
Employer: MMS Group
Location: St. Louis, Missouri
Job Type: Full-Time
Career Level: Experienced
Experience: 5-10 years
Education Level: Bachelor’s Degree
Oversee activities of the provider contracting, network development and/or provider relations functions and aid in formulating and administering organizational policies and procedures.
- Oversee provider contracting activities to ensure efficiency and maintain compliance with the business unit’s policies and standards, government laws and regulations
- Implement development activities for the recruitment and contracting of provider networks in new and prospective markets, and existing market expansions.
- Support new business launch in diverse markets while considering individual market circumstances, provider community, budgeting constraints and available resources
- Perform complex financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives
- Oversee contracting and network development staff and external consultants in the development of provider networks for new and expansion markets
- Monitor performance, develop, and implement business solutions to address process and quality gaps, and communicate network strategy and planning
- Ability to travel Act as provider network subject matter expert for Medicare Advantage and Complex Care (Medicaid-Medicare Partnership, Long Term Supports & Services, Foster Care, etc.) products bringing experience in network management and service area expansions
- Liaise between corporate product organization, health plan network teams, health plan product teams, and other leaders to deliver on product and network objectives
- Be able to dig into details, analyze data, develop project plans and development plans
- Communicate effectively at all levels of the organization
- Bachelor’s degree in Business Administration, Health Care Administration, related field or equivalent experience.
- 7+ years of combined contracting, network development or provider relations experience.
- Previous experience in Medicaid/Medicare contracting and negotiating hospital, large physician groups and ancillary service agreements.
- Previous management experience including responsibilities for hiring, training, assigning work and managing the performance of staff.
License/Certification: Valid driver’s license.