Dir, Ntwk Ops Engagement

Profile We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary Director will focus on operational oversight and service accountability for a portfolio of key and large groups and health systems within an assigned geographic market/region. Responsibilities include servicing issues, leading operational reviews and overseeing solution design and service recovery efforts with providers. This role will support TriWest's MVS team with healthcare access needs, assist with engaging providers to support Value Base Care initiatives, and partnering with Network Contracting and Subcontractor teams to advance strategic and operational initiatives for both VA (CCN) and DHA (TRICARE). Responsible for the performance of the network within the designated market in conjunction with other teams to include: Provider Network Managers, Military & Veteran Services (MVS), Provider Relations, Data, Claims, Credentialing, and Project Managers. Ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues with directly contracted providers throughout the assigned region. Facilitates resolution of escalated provider issues and promotes TriWest Corporate initiatives. Reports to the Vice President of Provider Network Operations. Education & Experience Required Bachelor's degree in Business, Health Care Administration or equivalent experience U.S. Citizen Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation 7+ years of leadership and/or account management experience in managed care, a health plan, or a health system, including provider network or payer-provider relationship management Working knowledge of provider contracts with health systems, hospitals, or large provider groups, including reimbursement, discounts, and contract terms Demonstrated success resolving complex conflicts, driving results with internal and external partners and stakeholders, and proactively managing issues Experience and fluency in health plan credentialing, provider data systems, healthcare analytics, and/or performance management Preferred Experience negotiating with multi-state health systems or national provider groups Experience with government healthcare programs (VA CCN, TRICARE, Medicare) Experience within managed care, provider network operations, or related healthcare environments, including provider network delivery, network data management, credentialing, provider services, contracting, project management, claims issue resolution, or other related provider operations functions Knowledge or experience with military culture or military healthcare Familiarity with Medicare, Medicaid, or Commercial payment and claims processing rules Key Responsibilities Develops and maintains relationships with providers and customers within a designated market of states. Ensures that network adequacy objectives are attained in all geographic areas of responsibility. Lead partnership, advocacy, and service delivery for a portfolio of Health Systems across multiple states, along with large Provider Group strategic partnerships and National providers Support MVS Field Staff and Military Treatment Facility/VA Medical Center network/provider needs in their regions. Could include triangulating key discussions with providers/field, reporting and monitoring access to services, as well as visibility in person at outreach engagements. Measures performance of all defined Service Level Objectives. Monitors network in coordination with other Provider Services Directors to ensure adequacy is being achieved and institutes corrective actions to address shortfalls in network. Directs workflows tied to resolving all network issues within assigned territories across functional teams within the organization. Monitors and ensures dotted-line teams are following through on resolution of routine and escalated provider issues. Communicates information regarding market needs, competition, and industry trends to management team. Maintains client confidence and ensures confidential information is protected. Works with Network Strategy and Provider Contracting leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them. Meets regularly with assigned health systems and key provider groups on performance factors, network requirements, contractual change orders, and all planning and maintenance issues. Oversees development and training to network providers on changes and updates to TriWest processes and policies. Demonstrates and maintains current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals. Reviews systems/workflow processes and procedures to identify/recommend opportunities for productivity and process improvement. Collaborates closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes. Heads or participates in projects and committees assigned by Vice President. Performs other duties as assigned. Regular and reliable attendance is required. Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. Leadership: Ability to lead and influence without direct authority; aligns matrixed and dotted-line teams toward shared outcomes; provides direction to cross-functional partners and holds them accountable to commitments. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VAPC3), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel. Working Conditions Availability to work non-regular hours as necessary Works within a hybrid environment Travel up to 20% Must be able to obtain appropriate security clearance Company Overview Taking Care of Our Nation’s Heroes. It’s Who We Are. It’s What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve! Our job is to make sure that America’s heroes get connected to health care in the community. At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: Medical, Dental and Vision Coverage Paid time off 401(k) Retirement Savings Plan (with matching) Short-term and long-term disability, basic life, and accidental death and dismemberment insurance Tuition reimbursement Paid volunteer time TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $164,000 to $173,000 per year. Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws. #J-18808-Ljbffr TriWest Healthcare Alliance