Director, Network Development
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Job Description
Director of Network Development responsible for dental provider network management and recruitment. Leading departmental activities to support provider relations and compliance with regulations.
Responsibilities:
- Effectively lead and manage recruitment and administration team.
- Develop recruitment plan with leadership and sales to target and prioritize recruitment areas including expansion opportunities.
- Direct Provider Development Managers and staff to meet targeted recruitment goals.
- Act as liaison between Network Development and various Dominion administrative departments.
- Responsible for provider compliance with state and federal regulations.
- Oversees complaint processes and procedures.
- Maintain current knowledge of industry and technical issues through participation in seminars, workshops and publications.
- Identify and recruit providers as necessary to ensure the development of a provider network compliant with CMS network adequacy and other entity requirements.
- Coordinate with Actuarial, Finance and the Senior Team the review and development of provider fee schedules that will help ensure the growth of Dominion National’s provider network.
- Ensure provider demographic and rate related information is captured and properly loaded in all Dominion systems consistent with company policy.
- Recruit, manage/oversee the training of new employees, as well as developing and applying appropriate policies and procedures for Network Development activities, including compliance.
- Direct the ongoing operations of the Provider Network, including the development of reports to measure the overall functioning of the department to ensure adherence to all performance metrics.
- Participate in the evaluation, recruitment, and management of vendors for specialized services.
- Participate and represent department in cross-functional standing committees as requested.
- Monitor daily performance of staff to ensure adherence to all performance metrics and promptly identify necessary corrective actions.
- Build strong relationships with providers.
- Performs other duties as assigned.
Requirements:
- Understanding of and relevant experience in commercial and Medicare populations and lines of business.
- Proven effective communications skills (verbal, written, presentation) with all types and levels of audiences.
- Proficiency with MS Office applications (word processing and database/spreadsheet).
- Excellent analytic, interpersonal, project management, negotiation and leadership skills.
- Critical thinking, problem-solving and collaborative team-player mindset.
- Confidence in taking ownership of work processes with only high-level direction and guidance;
- Ability to lead people and inspire them to do their best.
- Knowledge of reimbursement principles and state and federal Medicare/Medicaid financing rules and regulations.
- Minimum 7 years of dentist recruitment focused in the Group Health/Dental fields necessary.
- Minimum 3 years of leadership experience at a health plan.
- Proven ability to effectively manage in a matrix organization.
- Previous experience with implementation and expansion of a health plan business unit or division.
Benefits:
- Medical, Dental & Vision coverage
- Retirement Plan
- Generous time off including Paid Time Off, Holidays, and Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- and more.
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