Director - Provider Network Management - Beacon Health Strategies - Woburn

Job description

The Director of Network Operations is responsible for the network strategy and operations at Beacon Health Strategies, LLC, including setting department strategy and initiatives, provider credentialing and contracting, day-to-day operations, and ongoing collaboration with and support to Plans and other Beacon departments.

PRIMARY RESPONSIBILITIES



Define and implement network management strategies.

Develop and lead network management operations.

Act as liaison and maintain productive working relationships with all Beacon departments, as well as with client health plans.

Design, develop and implement initiatives for improved workflows and operations, and for network enhancement/expansion, particularly between the Under general supervision, provides support to patients, their families, and physicians in addressing medical and social concerns. Educates patients and families to make informed personal health care decisions. Facilitates communication between patient, physician, health plan, and community. Requires RN with typically three to five years of clinical and case management experience.Network and Clinical departments.

Direct and oversee all activities of the Network Operations department, including provider procurement/network expansion, contracting, credentialing, provider relations, database management, site visits, workflow improvements, development/revisions of department P&Ps, and provide ongoing supervision of staff.

Development and execution of a robust provider rate strategy in all networks

Manage a clear provider relations strategy, including provider profiling, bulletins, provider trainings/orientation and web engagement.

Manage efforts to increase provider electronic transactions and communication methods

Participate in Directors meetings, and other meetings and committees relating to Beacon business.

Respond personally to and/or facilitate resolution of provider issues raised by providers and/or Beacon staff; coordinate and lead internal/external meetings.

Monitor provider utilization and profiling information to identify providers who warrant closer attention; organize meetings with identified providers

Coordinate with IT to develop new systems needs for network management and reporting.

Responsible for NCQA compliance with all credentialing standards

Responsible for NCQA Access and Availability Standards.

Lead network strategy in the new business development and client implementation processes.

Responsible for Network reporting

Desired Skills and Experience

EXPERIENCE/EDUCATION:

Masters degree in health or human services/Administration.
5+ years management experience in a health care organization, managed care preferred.
Experience in all aspects of network development.
Excellent analytic, verbal and written communication skills.

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