Profile
We offer remote work opportunities in the West for this position (AK, AZ, CA, NV, NM, OR, UT, & WY only).
Our Department of Defense 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
Develops and maintains provider relationships within designated state/territory, inclusive of relationships with both TriWest Network Subcontractors and any directly contracted provider groups. Manages network development activity with network subcontractors/network providers to ensure network meets all access standards. Provider network includes hospital, physician and ancillary service agreements. Provider Network Manager ensures adherence with government operational manuals, monitors network access, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives. Ensures that Network Subcontractors fulfill all performance obligations defined in their Health Network Agreement.
Education & Experience
Required:
- Bachelor's degree in Business, Health Care Administration or equivalent experience
- 2+ years of experience managing large or complex provider networks
- 5 years of experience in a Managed Care or equivalent health care environment
- 2+ years of experience managing provider contracts including pricing, discounts, and all associated terms and conditions
Preferred
- Experience in provider contracting for government programs and/or commercial lines of business
- Has established relationships and resides in the market for the which the position is located
- Management experience in the healthcare industry
- Experience in utilizing a contract management system to manage contracting workflow
- Negotiation experience
- Understanding Claims issues and terms
Key Responsibilities
- Maintains relationships with Network Subcontractors in state/market of operations.
- Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics.
- Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to department leadership for inclusion in overall network development plans.
- Coordinates with Federal stakeholders to deploy network solutions to adhere to requirements of the contracts held by TriWest.
- Collaborates with Federal stakeholders to identify areas of provider training and education to be incorporated into the TriWest provider education plan.
- Aligns with Network Subcontractors and Federal Stakeholders to identify areas of opportunity for deployment of alternative payment models to support TriWest’s network and improve health care outcomes.
- Collaborates with internal leadership team to address network access.
- Supports providers as needed, with issues related to claims, referrals, or any other program related activity.
- Demonstrates and maintains current knowledge of all 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.
- Monitors and responds to network shortfalls within region through coordination with network subcontractors where appropriate.
- Regularly reviews and determines appropriate network access and development and makes recommendations to support network build activities.
- Provides regular updates to department leadership regarding provider network development, management, and access for assigned areas.
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- Communicates information regarding market needs, competition, and industry trends to management team.
- Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues.
- Regularly meets with network subcontractors/network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
- 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 Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy 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 Network Subcontractor relationships and associated contracts; takes accountability and follows through on service related requests. Responds with an appropriate sense of urgency.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
Technical Skills: Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VA Community Care Network), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Working Conditions
Working Conditions
- Availability to work non-regular hours as necessary
- Works in a hybrid environment, with travel as needed
- Must be able to obtain security clearance as required by government contracts
Company Overview
Taking Care of Our Nation’s Heroes.
It’s Who We Are. It’s What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!
Our job is to make sure that America’s heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, 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
Equal Employment Opportunity
TriWest Healthcare Alliance 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 cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
