Mgr, Network Ops - Reno Based Candidate is Preferred!

Description:

GENERAL SUMMARY
We are looking for a candidate who will live or have strong ties/experience in the Reno/Northern area of Nevada. Primary responsibility will be negotiating and managing the hospital and provider network in the Reno/Northern area of Nevada.This person would be responsible for provider contracting and/or provider relations pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers' compensation. Will manage department staff by providing oversight of the department's policies, procedures and practices.

ESSENTIAL RESPONSIBILITIES
- Assesses, recruits, and organizes vendors for provider networks. Manages the establishment and continual updating of provider databases.
- Oversees the maintenance of working relationships with the existing network, and assists in the recruitment of new providers.
- Reviews and facilitates Requests for Proposals (RFPs) from ancillary providers whose services match a need for entering into a contract.
- Negotiates complex contracts with physician, ancillary, and hospital providers. Acts in an advisory capacity to the Legal Department with regard to the financial and legal impact of provider contract language requested.
- Manages service to provider practices by resolving problems and advising providers of new protocols, policies and procedures.
- Compiles, maintains, and analyzes all plans' physician fee schedules including participating PCPs, participating specialists, and non-participating physicians for the purpose of identifying cost savings opportunities.
- Compiles, maintains, and analyzes all hospital rates for the purpose of identifying cost savings opportunities leading to local initiatives.
- Serves as the entry point and system of checks and balances between network development and other departments for the purpose of reviewing risk based provider contracts.
- Analyzes and recommends resolutions of contract barriers, taking into account prevailing local practice patterns and medical dynamics of multiple locations.
- Develops and generates appropriate reports on size, magnitude, cost effectiveness and comparative marketability of networks for internal and external customers.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.

Qualifications:

JOB SPECIFICATIONS
- Bachelor's degree or equivalent experience.
- Significant experience (usually 5-7 years) in managed care.
- Previous experience (usually 3 to 4 years) in a lead network operations or similar position preferred.
- Expert knowledge of provider (physician, ancillary and hospital) contracting/negotiations, provider relations and configuration, standards for managed care delivery and cost containment programs.
- In-depth experience with regulated lines of business.
- Substantive knowledge of managed care policy and direction.
- Strong communication and negotiation skills.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.

Job: First/Mid Level Officials and Managers
Primary Location: Las Vegas, NV, US
Other Locations: ,
Organization: 30400 - Coventry Health & Life - NV
Schedule: Full-time
Job Posting: 2013-08-16 00:00:00.0
Job ID: 1312620