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Amida Care · 3 months ago

Senior Director of Network Operations

New York, NY, US

Full-time

Onsite

Director/Executive

$132K/yr - $164K/yr

7+ years exp

Amida Care is the largest Medicaid HIV Special Needs Plan in NY, dedicated to providing access to comprehensive care and coordinated services for positive health outcomes. The Sr. Director of Network Operations will oversee the Provider Services Department, ensuring the development and maintenance of a network of providers to deliver Plan benefits effectively.

Child CareHealth CarePharmaceutical

Diversity & Inclusion

Responsibilities

Serve as the senior leadership point person for provider network services and performance in all activities, meetings, and committees of the organization and with internal and external audiences, including providers, vendors, and State regulators

Ensure regular site visits with provider community to proactively engage with providers and seek out opportunities to strengthen relationships

Responsible for oversight, management and reporting for all providers participating in the Quality Incentive Program. Develop value-based contracting metrics and contract monitoring procedures

Drive the design and development of a robust suite of analytical tools and provider performance metrics that will serve to enhance provider performance strategies, priorities, and activities as a key factor in achieving results

Acts as a business sponsor and owner for all Provider departmental reporting and technology system’s needs

Develop and retain effective relationships with physicians and business leadership of key physician groups, to drive business results

Perform financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives

Develop and implement clear and documented processes for provider operations (e.g. provider manual, provider communications, and provider on-boarding)

Negotiate hospital, physician groups and specialty contracts/service agreements in accordance with Corporate, health plan and government regulations and guidelines

Oversee the development, maintenance, and reconciliation of physician risk contracts and capitated arrangements in partnership with internal support teams such as Finance, and Value-Based Operations

Responsible for timely and accurate reporting for regulatory and compliance related activities

Responsible for the hiring and retention of quality staff and the on-going planning, monitoring, training, coaching, evaluation, and appraisal of staff performance and development to ensure successful achievement of goals and objectives

Other duties as assigned

Qualification

Contract negotiationsNetwork developmentProvider engagementHealth Plan experienceNew York State MedicaidAnalytical skillsMicrosoft OfficeCultural sensitivityBehavioral alignmentOrganizational skills