Manager of Network Development in Ontario, CA at Prime Healthcare

Date Posted: 2/9/2020

Job Snapshot

Job Description

Overview
The Manager of Network Development is responsible for negotiating agreements with integrated healthcare delivery systems, hospitals, ancillary providers, physicians and physician groups that result in the Prime Healthcare EPO Tier 1 network having high quality, cost effective and marketable providers. This position is accountable for ensuring effective implementation of new as well as renewed contracts through communication and coordination with other functional areas. This position creates, negotiates and incorporates Prime Healthcare EPO Tier 1 contracts as well as renegotiating contracts to accommodate scope changes or changes in organization requirements. This position may lead related initiatives and projects. Working with hospital CEOs and Business Development is an integral part of the job. Travel is required to meet with Provider Groups at multiple locations, primarily outside of California. #LI-CC1
 
Note: This position is not responsible for the Prime Healthcare Employed Physician Groups but is expected to integrate with them.

Responsibilities

1. Ensures effective implementation of new and renewing contracts through communication and coordination with other functional areas.Note: Only for Contracted but not Employed Physician Groups. 2. Oversees the corresponding credentials and maintenance of the contract files in an orderly manner.3. Follow up with physicians and/or vendors on the status of a contract and/or missing information to achieve closure.4. Efficiently and effectively coordinates files of the Health Plans privileged providers and keeps the UR department abreast of changes including addition and termination of providers monthly. 5. Ensures the efficient management of the Prime Healthcare Benefit Department’s provider contracts; including overseeing the maintenance of the master contract file.6. Adheres to Prime Healthcare contracting policies, procedures and financial guidelines.7. Initiates Letter of Agreement (LOA) process as requested by Prime UR.8. Ensures that provider contracts received in a timely manner (one business week turn around).9. Ensures directory updates monthly to Prime UR and Claims Departments plus TPA and On-line Enrollment Vendor.10. Oversees the current Directory intranet load for all Prime facilities. Manages and controls the contractual relationship with contracted but not employed providers11. Gathers relevant data regarding financial and operational performance as well as other competitive information necessary for job function.12. Works with VP of Employee Health and other corporate resources as necessary to identify Tier 1 PCP and specialty needs by location.13. Performs necessary analysis of cost and utilization data in addition to the analysis of the financial and operational impact of contractual proposals.14. Ensures corporate goals and objectives for approved initiatives and projects are completed within established timeframes and financial parameters.15. Travel to Hospital sites as directed to discuss specific Tier 1 provider coverage needs with hospital C-suite and Business Development.16. Travels to Hospital sites to directly engage providers and provider groups to negotiate their inclusion as Tier 1 providers.17. Performs other duties as assigned or required.

Qualifications

Required qualifications:
1. Previous experience in contract development and negotiation with physicians and physician groups.2. Bachelor’s degree in Health Care Administration or related field or equivalent work experience required and five (5) years’ experience in Self-Funded Plans, OR 3. Master’s degree in Health Care Administration or Management and four (4) years’ experience in Contracting model setting, OR 4. Any appropriate combination of education and experience. 5. Ability to travel
 
Preferred qualifications:
1. Experience with Self-Funded (ERISA) Plans
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf