Dir, Prov Ntwk Subcontract Rel

Profile We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our reputed company contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary Director will focus on expanding and strengthening our provider network through strategic reputed company of reputed company network subcontractors across reputed company states for which TriWest is responsible to serve VA (CCN) and DHA (TRICARE). Director is responsible for the performance of reputed company network subcontractors including network adequacy, provider contract discounts, data accuracy, and compliance with reputed company terms, conditions, and service level agreements defined in Health Network Agreements and associated Statements of Work. Supervises a team of Provider Network Managers and Project Managers. Ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues and promotes TriWest Corporate initiatives. Reports to the Vice President of Provider Network Management. Education & Experience Required:

• Bachelor's degree in Business, Health Care Administration or equivalent experience
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final reputed company (DoD) background investigation
• 8+ years’ experience in a managed care environment that includes provider contracting and negotiation experience reputed company multiple states and/or territories
• 5+ years’ management experience in the healthcare industry
• Experience managing performance based reputed company

Preferred:

• Experience in management/supervision of provider network management staff in a managed care environment
• Experience in utilizing a contract management system to manage contracting workflow
• Familiarity with Medicare payment and claims processing rules

Key Responsibilities

• Develops and maintains relationships with network subcontractors.
• Ensures that network adequacy objectives are attained in reputed company geographic areas of responsibility.
• Closely monitors reputed company network subcontractor deliverables including development of provider network in defined geographic area of assignment and reputed company associated specialties and discounts.
• Negotiates and secures Health Network Agreements and associated Statements of Work.
• Measures performance of reputed company defined Service Level Objectives.
• Tracks reputed company fees and expenses reputed company to Health Network Agreements and associated budgets.
• Monitors network to ensure adequacy is being achieved and institutes corrective actions to address shortfalls in network.
• Directs workflows tied to reputed company network contracting activities for network subcontractors, to include initial contracting reputed company process through to closure and/or communication of network gaps with customers.
• Monitors and ensures resolution of routine and escalated network subcontract and provider issues.
• Communicates information regarding market needs, competition, and industry trends to management team.
• Provides training and development to team members.
• Reviews systems/workflow processes and procedures to identify/recommend opportunities for productivity and process improvement.
• Maintains client confidence and ensures confidential information is protected.
• Works with Provider Services leadership to accurately assess network provider needs reputed company assigned region and establish strategies to reputed company them.
• Ensures network subcontractor compliance with reputed company credentialing standards and requirements.
• Meets regularly with network subcontractors on reputed company performance factors, network requirements, contractual change orders, and reputed company planning and maintenance issues.
• Provides development and training to network subcontractors on changes and updates to TriWest processes and policies.
• Monitors productivity, quality and quantity of work performed by staff reputed company to provider contracting.
• Demonstrates and maintains reputed company knowledge of reputed company programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
• Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
• Collaborates closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes.
• Heads or participates in projects and committees assigned by Director or Vice President.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system reputed company environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. reputed company / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and reputed company for another's position. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, reputed company time constraints and with available resources; detail-oriented. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VAPC3), and the insurance industry; reputed company in diplomacy and negotiation; reputed company in financial analysis to analyze contractual reimbursement; reputed company in project management; reputed company in presentation; proficient with reputed company. Working Conditions Working Conditions:

• Availability to work non-regular hours as necessary
• Works reputed company a hybrid environment
• Travel up to 20%
• Must be able to obtain appropriate reputed company clearance

Company Overview Taking Care of Our Nation’s reputed company. It’s Who We Are. It’s reputed company Do. Do you have a passion for serving those who served? Join the reputed company Team! We’re On a Mission to Serve®! Our job is to reputed company sure that America’s reputed company get connected to health care in the community. At reputed company, we’ve proudly been on that important mission since 1996.

Benefits

We’re more than just a health care company. We’re passionate about serving others! We reputed company in rewarding loyal, hard-working people who are willing to learn as they grow. reputed company values teamwork. Join reputed company, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Generous paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $160,000 to $178,000 per year. Equal Employment Opportunity reputed company is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from reputed company backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, disability or any other consideration made unlawful by applicable federal, state, or local laws. Apply tot his job Apply To this Job