Description:
GENERAL SUMMARY
- Participates on network management team to set strategic direction for the health plan and/or network based business in collaboration with other functional areas.
- Develops and implements provider compensation strategies to maintain quality, cost-effective provider networks for commercial and government programs product lines.
- Establishes strategic and tactical direction for recruiting, contracting, credentialing and maintenance of the provider network.
- Develops and maintains contracting strategies for all product lines as well as major networks.
- Reports on status of all contracting activities.
- Develops and generates appropriate reports on size, magnitude, cost effectiveness and comparative marketability of various networks.
- Ensures compliance of all contracting and provider relations initiatives with applicable State and Federal laws and regulations.
- Contributes to the company’s strategic goal of becoming the leader in delivery of managed care.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
- Bachelor's degree or equivalent experience. Master’s degree preferred.
- Significant experience (usually 7+ years) managed care experience, 4-6 years strategic operational experience in network development.
- Substantive knowledge of managed care policy and direction.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Louisville, KY, US
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2012-08-22 00:00:00.0
Job ID: 1210898
GENERAL SUMMARY
Responsible for the development, negotiation, implementation, management, and financial impact determination of all contracts pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and worker’s compensation. Establishes provider contracts and reimbursement mechanisms, sets negotiation strategies, participates in contract negotiations, and determines integrated delivery system contracting practices and procedures. Develops and considers new and creative contract terms, including fixed pricing arrangements, exclusive arrangements, joint ventures, and acquisitions. Implements defined strategies and activities related to the plan's physician, hospital and ancillary services relations. Directs provider recruitment,
orientation and training, and provider relations.
ESSENTIAL RESPONSIBILITIES
- Participates on network management team to set strategic direction for the health plan and/or network based business in collaboration with other functional areas.
- Develops and implements provider compensation strategies to maintain quality, cost-effective provider networks for commercial and government programs product lines.
- Establishes strategic and tactical direction for recruiting, contracting, credentialing and maintenance of the provider network.
- Develops and maintains contracting strategies for all product lines as well as major networks.
- Reports on status of all contracting activities.
- Develops and generates appropriate reports on size, magnitude, cost effectiveness and comparative marketability of various networks.
- Ensures compliance of all contracting and provider relations initiatives with applicable State and Federal laws and regulations.
- Contributes to the company’s strategic goal of becoming the leader in delivery of managed care.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor's degree or equivalent experience. Master’s degree preferred.
- Significant experience (usually 7+ years) managed care experience, 4-6 years strategic operational experience in network development.
- Substantive knowledge of managed care policy and direction.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Louisville, KY, US
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2012-08-22 00:00:00.0
Job ID: 1210898