Director - Network & Provider Management

Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

The Director of Network & Provider management is responsible for overseeing the development and management of the healthcare provider network for Prudential. This includes negotiating contracts with healthcare providers, ensuring network adequacy and maintaining positive relationships with providers to ensure high-quality care for members.

Role and Responsibilities

• Developing and implementing strategies to build and maintain a high-quality provider network and TPAs where needed.
• Negotiating contracts with healthcare providers, including fee schedules and performance metrics.
• Monitoring network performance and provider satisfaction and implementing improvements as needed.
• Identify global best practices in provider management for adoption, as appropriate in markets.
• Collaborating with internal teams, such as operations, finance, and quality management to ensure network alignment with organizational goals.
• Analyzing data and trends to identify opportunities for network expansion and optimization.
• Perform analytics on network providers to assess performance metrics and provide insights for LBUs.
• Ensuring compliance with regulatory requirements and accreditation standards related to provider network management.
• Leading a team of network management professional and providing guidance and support to achieve goal.
• Develop framework to evaluate medical service providers and their value delivery, integration and funding model.
• Develop framework/guidelines & support LBUs in conducting agreed fee/discount negotiations with providers on price, volume and outcome.
• Define standards for partnership identification, support LBUs in assessing partners’ ability to deliver appeal and sustainability by conducting clinical due diligence.
• Define standards and support LBUs in enhancing capabilities in pharmaceutical benefits management.
• Closely works with Claims team for feedback to providers and vice-versa to claims team on findings from analytics on provider performance.

Qualifications

• Bachelor’s degree in healthcare administration, business administration or a related field
• Proven experience in network and provider management, healthcare administration with minimum of 7+ years of experience in leading a team.
• In-depth knowledge of healthcare regulations, compliance requirements and industry trends
• Excellent communication and negotiation skills, with the ability to build and maintain relationship with providers.
• Proficiency in data analysis and reporting, with the ability to use data to drive network optimization and cost containment strategies.
• Knowledge of healthcare IT systems and network management tools
• Strategic thinking and problem-solving skills, with the ability to develop and implement network strategies to meet business objectives.

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.