Personify Health · 6 hours ago
Director, Network Management
United States
Full-time
Remote
Director/Executive
$125K/yr - $175K/yr
7+ years exp
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Responsibilities
Support development and execution of strategic initiatives to expand and optimize existing networks, focusing on growth, access, and quality.
Analyze market trends and regulatory changes to adjust network strategies and meet organizational objectives.
Manage business relationships with Payer and Health System partners to support goals including membership growth, retention, margin and quality.
Negotiate and maintain contracts in partnership with legal, focusing on cost management, quality and compliance.
Develop and oversee network performance metrics.
Identify opportunities for stronger partnerships and collaborate with sales on RFPs/RFIs.
Build network reporting package and heat map to inform growth and expansion opportunities.
Partner with compliance and legal teams to ensure compliance with all relevant regulatory and accreditation standards.
Oversees network administrative functions including but not limited to: the provider portal system, policies and procedures, RFPs, network disputes and settlements, and network regulatory activities.
Collaborate with finance, sales, product, and medical management teams to align network strategy with organizational priorities.
Work together with sales to develop network expansion, network and partnership strategies by region.
Support business development efforts by providing network insights, reporting and analysis for prospective opportunities.
Qualification
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Required
Bachelor’s degree in Business Administration, or a related field OR equivalent experience; a master’s degree is a plus
7+ years proven experience in network management within a carrier or TPA space with a strong understanding of contract pricing and its impact on P&L
Experience in self-funded administration
Excellent communication skills with the ability to convey complex information clearly and effectively to various stakeholders
History of cultivating and managing external stakeholders
Strong presentation skills, analytical and problem-solving skills, with a keen attention to detail
Strategic thinker with the ability to participate in and contribute to high-level planning discussions
Ability to work independently and collaboratively in a fast-paced and matrixed environment
Advanced organizational skills with ability to handle multiple assignments/projects at once
Benefits
15% target bonus/variable compensation
Health, dental, vision, mental health and other benefits
Company
Personify Health
Personify Health is a software that provides health plan administration, comprehensive health navigation, and holistic well-being solutions.
1,001-5,000 employees
Funding
Current Stage
Late StageRecent News
2024-11-15
2024-11-01
2024-11-01
Company data provided by crunchbase
