Director, Network Management in Wayne, Pennsylvania at Coventry

Coventry
Director, Network Management

US--Remote

Job ID: 24-17106
Type: Regular Full-Time
# of Openings: 1
Category: Corporate
Mitchell International, Inc.

Overview

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

Responsibilities

Responsible for the overall performance of a regional / segment of the WC / Auto Network. Design, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for WC and Auto Claimants ; foster growth of WC and Auto products ; and enhance profitability for Coventry, and increase satisfaction of WC/Auto Clients. Leads and manages teams of employees who develop, negotiate, contract, and enhance provider networks of high quality, are cost efficient, and will improve healthcare for our customers. Oversees the development of programs to maintain and enhance collaborative provider relationships and operational effectiveness. Maintains accountability for related compliance, quality and financial goals. Manages a high functioning team responsible for ensuring overall network competitiveness and profitability for a given geographical area or assigned provider type.

Note: The Director’s responsibility and complexity may vary by market size and the need for units may be organized around services such as hospitals, physicians, providers, or all; the type of contract, such as fee for service or value based, compliance functions and or cost management efforts.

Qualifications

• 8 – 10 years related experience
• Bachelors degree, Masters degree, or equivalent work experience
• Experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface
• Experience building and maintaining relationships with provider systems
• Knowledge of WC / Auto contracting a plus
• Knowledge of Ancillary Rate schedules
• Successful track record managing and negotiating major provider contracts
• In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and physicians/providers
• In-depth knowledge of managed care business, regulatory /legal requirements
• Solid leadership skills, including staff development and Talent Management

Salary: