Manager, Provider Network Development

Position Overview

Responsible for the overall strategy and development of Zelis contracted network providers (current and prospective) in an effort to increase the savings achieved for Zelis clients for existing and new products.

Cultivate organization’s’ overall direct contracted PPO assets to support multiple products and achieve corporate objectives for PPO product viability.

Summary of Responsibilities

• Serve as a resource for all providers in a variety of markets, in particular large and key strategic groups and health systems, and national arrangements
• Negotiates complex contracts and coaches contracting team for network development efficiency.
• Executes corporate contracting strategy for multiple product lines (primary, OON, government, workers compensation, etc).
• Establish strategic relationships with all types of providers
• Answer complex questions and provide information about procedures or contracts
• Assist business operations with contract terms and educating company key personnel about such contract terms
• Develops and provides plan support and contracting leadership, as required.
• Compiles, maintains, and analyzes provider and hospital fee schedules to identify cost savings opportunities.
• Develops and communicates network development goals including target acquisitions, claim dollars captured, and revenue achieved.
• Provide continuous feedback and updates to organization’s direct contract strategy.
• Create and manage tools necessary to capture provider targets, measure performance and provide feedback and recommendations to executive team.
• Recruit, coach and mentor Network Development staff. Initiates and effectively communicates a variety of human capital related actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
• Performs other duties as required.

Summary of Qualifications

• Bachelor’s degree or equivalent experience.
• Advanced understanding of contract language and can explain according to audience
• In-Depth level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
• In-Depth knowledge of provider contracting / negotiations, network development and configuration, standards for managed care delivery and cost containment programs.
• In-Depth knowledge of managed care policy and direction.
• Strong knowledge of product lines including group health, workers compensation, dental and government business.
• Management of strategic operational and technology initiatives.
• Strong working knowledge of MS Excel, computer systems, applications and operating systems.
• Experience managing projects and process innovative changes effectively.

EXPERIENCE

• Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.
• Demonstrated thought leadership and motivation skills
• Self-starter
• Ability to research and resolve
• Excellent skills in critical thinking and analysis, project management, meeting facilitation, and interpersonal interactions (e.

g., partnering, conflict management, consulting, etc.)

• Must be available to travel 25% - 50% as required to meet business needs.
• Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
• Relocation assistance is provided for this position.

work environment

• A standard work week exists but with the understanding that additional time / effort outside of the usual parameters can / will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.
• A standard business environment exists with moderate noise levels.
• Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
• Ability to sit for extended periods of time.
30+ days ago