Director, Network Optimization
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Job Description
Director overseeing strategic development and maintenance of Ohio Medicaid plan's provider network. Driving network optimization and compliance while collaborating across key leadership teams.
Responsibilities:
- Oversees the strategic development and maintenance of Ohio Medicaid plan's provider network
- Drives network optimization and value while ensuring compliance with network requirements
- Assesses provider network performance to inform contracting and terminations
- Works closely with the Provider Relations team to address network operational issues
- Sets value-based payment strategy
- Creates strategy for Ohio Medicaid provider network, including contracting approaches and unique partnerships
- Monitors performance against key performance indicators and contractual commitments
- Collaborates with leadership and clinical teams to achieve strategic goals and priorities
Requirements:
- Bachelor's Degree
- 6+ years of experience working with a managed care organization or as a consultant in a network/contract management role, such as contracting, provider services, etc.
- 2+ years of experience in provider network development, including contracting, network operations, and/or network maintenance
- 4+ years of experience in value-based contracting models
- 2+ years of experience in data analysis
- Proficiency with a wide range of physician/facility/ancillary contract reimbursement methodologies
- Prior leadership and management experience
- Ability to manage multiple priorities in a fast-paced environment
- Experience working in a matrixed organization and influencing change and direction
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Benefits:
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
- Many other opportunities
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