Director Network Development Medicaid HMO

Director Network Development
Medicaid HMO
Columbia, South Carolina

POSITION OVERVIEW
Serves in a leadership role in the team established for the recruitment and maintenance of a viable network for an established Medicaid Health Plan beginning operations in South Carolina. Manages elements of contracting, network development, and provider services activities.

POSITION DUTIES AND RESPONSIBILITIES

•Assists in the development and implement departmental policies/procedures for respective areas and ensure that standards are consistently achieved
•Responsible for the establishment of an effective health care delivery system including:
?Hospitals
?Primary Care Physicians
?Physician Specialists
?Ancillary Vendors
?Other

•Communicates financial terms with providers including per diem rates, global rate, and capitation arrangements.
•Implements standard fee schedules, administrative services reimbursement rates, and management fees.
•Responsible for input into provider services databases
•Assist in the development and coordination of provider network expansions into new localities for Medicaid product in accordance with regulatory adequacy guidelines
•Takes a lead role in improvement projects related to network development, contracting, and provider services
•Prompt and efficient response to provider or provider related issues with appropriate, objective documentation of concerns, recommendations of resolution, monitoring and re-evaluation.
•Automate and streamline operational processes.
•Contribute to preparation, update and production of all marketing and education materials/manuals.
•Demonstrated comprehensive understanding of applicable regulatory and contractual requirements.
•Perform other managerial duties as required
REQUIREMENTS
MINIMUM EDUCATION REQUIREMENTS

•Bachelors Degree in Health Services, Business Administration, or other related business fields


SPECIAL KNOWLEDGE AND/OR SKILLS

•Understanding of Medicaid healthcare insurance markets, the HMO concept, and business operations
•Proven direct sales ability
•Ability to manage multiple projects while meeting deadlines and achieving business goals
•Proven presentation, written, and analytical skills.

WORK BACKGROUND/EXPERIENCE

•Senior Management experience preferred
•3 years supervisory experience
•Proven sales and account management experience
•Healthcare or related experience working with providers and hospitals organizations

Reply to: 2399 Mgr Network JLD SC
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1-877-434-6837