Director, Network Development and Engagement(Military Program Experience Preferred)

Job Summary:

This position supports TRICARE Prime Demo by CareSource Military & Veterans, which aims to enhance healthcare access and prioritize the unique needs of the military community. We encourage military affiliated individuals, veterans, military spouses, and those with prior TRICARE experience to apply.

The Director, Network Development & Engagement is responsible for providing expert leadership, performance analysis, and ongoing support in the areas of provider network operations, designs and implements strategies to increase provider engagement, driving toward better quality, improved population health, and reduced healthcare cost.

Essential Functions:

• Provides strategic leadership to cross functional teams while coordinating services and support to achieve all engagement goals set forth by enterprise and the Market
• Monitor and ensure the health plan's execution of meeting or exceeding all appropriate requirements by Federal, State, and Accrediting bodies
• Ensures Health Plan complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards and participates in market audits
• Works with stakeholders to evaluate policy and process changes for potential provider impacts, monitors implementation of key initiatives, and provides leadership on initiatives affecting providers
• Ensure provider network is adequate, cost effective, competitive, stable and meets the corporate and regulatory access requirements
• Responsible for hospital, provider and ancillary provider contracting, service, and provider data integrity to facilitate optimal member access, successful business growth initiatives and sound plan financial performance as it relates to unit pricing in select states, regions or markets
• Provide oversight of provider contracting activities when completed by contractors or other individuals or entities working on behalf of the Health Plan
• Establishes objectives and annual goals in conjunction with leadership
• Collaborate with leadership on the development of Market Provider Engagement Model and business objectives with respect to Providers
• Responsible to execute on Market Provider Engagement Model and drive Market performance
• Ensure budget and financial goals are set and monitored; describe variance detail monthly
• Drive quality outcomes through execution and support of Value Based Reimbursement agreements with providers
• Foster external and internal intra/inter departmental relationships with hospitals, key physicians, community agencies, provider trade associations and key vendors
• Develop health plan Network policies, procedures and goals as needed to align with the market requirements and Health Plan strategy/model
• In collaboration with Quality Team, review audits of all provider performance from a productivity, performance and quality perspective; address issues as identified and develop appropriate action plans with reporting activities as needed
• Responsible for the development and communication of performance improvement measurements, working with the Provider Engagement team to develop strategies for success
• Produce team results that demonstrate engagement rates, low Grievances & Appeals, Continuous Improvement, Human Capital metrics that demonstrate leadership behavior is supporting improved outcomes, positive culture and consumer experience
• Develop and maintain an in-depth knowledge of the company's business, regulatory environments and high-level of Health plan knowledge
• Perform travel as needed to support program goals and key stakeholder engagement
• Perform any other job duties as requested

Education and Experience:

• Military affiliation or TRICARE experience is preferred.
• Bachelor of Science/Arts Degree or equivalent years of relevant work experience is required
• Master's degree in Business or Health Care preferred
• A minimum of five (5) years of leadership/management experience is required
• Five (5) years of Managed Care experience is preferred
• NCQA PCMH experience is preferred
• Demonstrated management of multiple regulatory and accreditation requirements of populations and programs

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
• Ability to operate smart phone, iPad, or other mobile communication devices
• Prior experience with and knowledge of provider contracting
• Knowledge of provider operations preferred
• Strong financial background
• Strong interpersonal skills
• Knowledge of managed care industry, trends, and accreditation
• Knowledge of quality improvement and HEDIS programs/outcomes measurement
• Excellent verbal and written communication skills
• Excellent leadership, management and supervisory skills
• Ability to work independently and within a team environment
• Attention to detail and work plan creation, implementation, and evaluation
• Critical listening and thinking skills
• Negotiation skills/experience
• Customer service oriented
• Decision making/problem solving skills
• Proven track record in driving continuous improvement efforts to improve member experience and tracked results
• Critical listening and systematic thinking skills
• Ability to attract, manage and develop team members; Inspirational Leadership
• Energetic, enthusiastic, and politically astute
• Strategic management skills
• Conflict resolution skills
• Planning, problem identification, and resolution skills

Licensure and Certification:

• Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated
• Employment in this position is conditional pending successful clearance of a criminal background check. If the criminal background results are unacceptable, the offer will be withdrawn or, if you have started in this position, your employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• Travel may be required to travel 25% to 50% of the time to perform work duties; a valid driver's license, car and automobile insurance are necessary for work-related travel
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer

Compensation Range:
$110,800.00 - $193,800.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

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