Director, Provider Network and Operations

Job Description

We are seeking a Director of Provider Network and Operations to ensure the financial stability, service excellence, and superior quality of our provider networks. This role involves overseeing the creation and execution of provider contracting strategies, managing negotiations, and ensuring contract fulfillment. This leader will spearhead provider contracting and servicing for business expansion, crafting strategies to foster and expand relationships with physicians, hospitals, and other providers. Responsibilities include defining network expansion needs, approving special requests and adjustments, and modifying networks to meet goals. Collaboration with physicians and internal teams is essential to align network strategy with clinical and financial objectives, ensuring our network provides high-quality, cost-effective care. This role requires monitoring industry trends, engaging with ACOs, and managing a team and budget to drive growth and industry leadership.

Qualifications

1. Bachelor's degree required, master's degree desirable. 2. Minimum 5 years of management experience. 3. Minimum 5 years experience in provider contracting and provider relations. 4. Must understand Medicare, RBRVS, case rate, capitation, and other related payment structures.

Benefits

- Health insurance - Retirement plans - Paid time off - Flexible work arrangements - Professional development