Dir Network Relationship WHP

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Job Summary:This position oversees and directs the management of a defined scope of the Wellstar Health Plan's provider contracts and relationships with providers including hospitals, health systems, physicians and other practitioners, ancillary providers, specialty networks, etc. The Wellstar Health Plan operating margin is highly dependent on the performance of these contracts. The director is responsible for implementing strategic initiatives related to these provider contracts, including the implementation, consultation, reporting and reconciliation of a variety of value-based contract options to engage and reward partner providers. The director will report to the Wellstar Health Plan Chief Financial Officer and will also work closely with all members of the plan's leadership team, including the development and refinement of the health plan's provider contracting strategy. The director will ensure that detailed reporting on contract yield will be maintained in a timely and accurate manner to facilitate actuarial review, pricing and trend analysis. They are responsible for managing, training and assisting the other health plan staff, as appropriate. Significant partnership and interaction with revenue cycle function. The director will ensure best coordination and cooperation with WHS managed care, WMG, WCP, Care Management/Population Heath, Data and Analytics and other internal system departments or external partners.
Core Responsibilities and Essential Functions:Oversee the negotiation and implementation of assigned managed care contracts for the System
* This includes the day-to-day responsibility of directly managing key managed care agreements and overseeing the remaining managed care agreements for any direct reports in the department.
* Participate in and lead rate negotiations and language negotiations for all assigned managed care payors for the department as appropriate.
* This includes training team members on reimbursement negotiation and contract language development and negotiation as needed.
* Direct and manage assigned direct reports which may fluctuate from time to time based on managed care need and structure.
Act as a liaison to other departments and represent WHP leadership within the WHS to ensure compliance and appropriate payment with existing provider contract terms.
* Represent WHP leadership to internal and external stakeholders with other important aspects of the WHP relationship with providers including but not limiting to pre-authorization processes, appeals, evidenced-based guidelines (EBM), physician relations, front office relations, patient/member complaints, access to care challenges, value-based care performance - quality and financial, value-based reported and reconciliation, physician practice reporting, provider communications and notices, and other aspects as required.
Manage day to day functions of Related to Assigned Payors
* Conduct joint operating committee meetings for assigned key payors and participate in all remaining joint operating committee meetings for the other assigned managed care payors.
* Participate and present as applicable in managed care team member and other system operational meetings for the department.
* Keep abreast of the current happenings with each assigned managed care payor and the managed care market as a whole.
Evaluate and manage contract yield and overall unit cost trends of all provider contracts individually and as a book of business
* Participate in the creation of an annual unit cost trend targets across all health care cost categories.
* Ensure all cost-of-living increases and charge master provisions for provider contracts are implemented timely, appropriately, and are audited for contract compliance.
* Design, implement and review unit cost trend reporting to ensure appropriate controls, forecasting, and contract compliance.
* Set appropriate contract renegotiation goals and identify strategic opportunities for the WHP by provider.
* Ensure contract changes are communicated to all internal and external stakeholders and loaded in appropriate systems for each contract.
Performs other duties as assigned
Complies with all Wellstar Health System policies, standards of work, and code of conduct.
Required Minimum Education:

• Bachelors Business Administration/Management or Bachelors Health Administration or Masters Business Administration/Management-Preferred

Required Minimum License(s) and Certification(s):All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):Required Minimum Experience:Minimum 10 years experience in healthcare or insurance industry Required and
Minimum 8 years experience with Managed Care contract negotiations and or Managed Care operations, experience managing and developing staff.
Required
Required Minimum Skills:Critical thinking skills
effective negotiation skills
ability to coach, mentor, and supervise management level staff
strong communication skills,
ability to resolve issues independently
ability to identify potential opportunities and threats to the system related to Managed Care contracts
ability to influence others.

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