Manager - Network Development

Overview Lead/support the development, negotiation, management, and maintenance of provider contracts for physician organizations, hospital, and ancillary facilities across the payment spectrum for HCS’ workers compensation/PIP network. Lead/support complex negotiations and/or contracting arrangements which require developing a sound business strategy for the financial and legal terms required for contracting initiatives. This role collaborates with Senior Leadership and Data Analytics to draft provider rate proposals that adhere to HCS’s unit cost guidelines and negotiates such proposals with hospital executives, physicians, and ancillary providers directly. The objective is to draft hospital, professional, and ancillary contract terms that conform with regulatory, accreditation and business requirements while advancing HCS’s strategic and business objectives. This manager should have a demonstrated track record of creating, developing, and managing successful network contracting strategies, with experience negotiating contracts with healthcare providers. The role leads a team of specialists and independent contributors. Excellent communication and leadership skills are essential as the manager will work with a range of stakeholders both internally and externally. The position will manage negotiations and contracting with all providers for all payment arrangements, and will recruit and contract out-of-network providers. Responsibilities Manage and negotiate contracts in compliance with HCS reimbursement standards. Assist and implement provider contracting policies and procedures that are consistent with industry best practices and regulatory requirements. Ensure accurate implementation of contracts in addition to working with other departments to assure contract and special arrangement reporting, provider database maintenance requests, and new hospital implementation. Conduct research, identify root cause analyses, and generate fall-out reports addressing operational deficiencies. Manage the maintenance of all provider contract language and templates and ensure that all negotiated contracts can be configured into the HCS systems. Collaborate with Legal and Compliance as needed to modify provider contract templates to ensure compliance with all regulatory, accreditation and business requirements. Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance across all lines of business. Coordinate across network management for submission of hospital, ancillary and professional rate loads, pricing configurations, and contract storage. Manage the effectiveness and efficiencies of operations including contract inventory management and adherence to regulatory requirements and internal policies. Understand the impact of contract provisions on claims payment accuracy and timeliness and present solutions to minimize deviations and support auto-adjudication. Understand the credentialing and recredentialing process, provider directory maintenance, and regulatory standards. Collaborate across departments to ensure provider services align with claimant and organizational needs. Assist with keeping the provider network integrated with the organization’s objectives. Provide management-level leadership and support for contracting staff. Assist the team with skills, knowledge, and resources needed to effectively manage the provider network and achieve team goals. Represent the organization at industry conferences, webinars, and other events. Ensure HCS is well-positioned to identify and capitalize on emerging trends and opportunities in the market. Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administer salaries for staff. Disclaimer This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job. Education / Experience High School Diploma/GED required. Bachelor degree preferred or relevant experience in lieu of degree in health or health care related field from an accredited college or university or relevant experience. Requires a minimum of 5 years demonstrated business experience in hospital and provider group finance and/or managed care network development. Requires a minimum of 5 years in-depth knowledge and understanding of contract finance and reimbursement methodologies including FFS, Workers Compensation/PIP pricing, and incentive arrangements. Requires a minimum of 5 years prior provider experience in a healthcare setting including but not limited to Workers Compensation, PIP, Commercial, Medicare, Medicaid, and/or Value Based Programs. Requires a minimum of 3 years’ experience in health care cost data analysis. Requires a minimum of 3 years supervisory experience and/or leading people by influence. Skills / Abilities Demonstrates ability to create, develop, and maintain business relationships. Proven analytical, business case, and product design skills. Proven ability to exercise sound judgment. Proven ability to ask probing questions and obtain thorough and relevant information. Must be detail oriented with strong organizational skills. Proven ability to follow detailed instructions and solve problems. Demonstrates flexibility and adaptability to multiple responsibilities within the organization. Must demonstrate the ability to effectively present information and respond to questions from groups of managers and clients. Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Knowledge Must be proficient in the use of personal computers and supporting software in a Windows-based environment, including MS Office products (Word, Excel, PowerPoint); should be knowledgeable in intranet and internet applications. Requires knowledge of principles of health care contracting. Requires knowledge of health care industry or health insurance industry. Requires knowledge of the hospital and physician communities in New Jersey. Requires knowledge of laws and regulations regulating workers compensation and PIP, HMO hospital and physician practice. Travel Position is remote with travel to the Newark, NJ office for department meetings. Requires moderate travel up to 30%. #J-18808-Ljbffr