Organization: The Ohio State University Wexner Medical Center
Location: Columbus, OH
Date Job Posted: September 14, 2021
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Scope of Position:
The Director of Network Management provides day-to-day leadership for all activities relating to the management of the Health Plan's provider network serving over 150,000 lives. The position oversees a revenue and expense budget of over $700,000 for each. The Director is responsible for achieving the financial and business objectives of its provider contractual relationships and collaborates with key internal and external stakeholders to ensure alignment across all functions and regions and is a key member of the Senior Leadership Team as well as an Executive of the Ohio PPO Connect Board.
The Director of Network Management plans, directs, and coordinates OSUHP activities related to contracting, network and information management, and credentialing; leads the development and execution of the OSUHP network strategy, including reimbursement, contract structures, and network configurations; actively manages provider portfolio, including both system and community providers; accountable for negotiation of contract terms and for meeting regulatory and business requirements; oversees provider-related financial analysis and is responsible for obtaining appropriate approvals for proposed contract terms; develops and maintains provider network relationships throughout the state; leads the planning and implementation of network servicing activities and resources to meet regional and corporate business goals; determines and implements all activities needed to insure in network satisfaction within the provider community; responsible for the credentialing program, ensuring high-quality standards are maintained; oversees credentialing staff and the conducting of audits and provide feedback to reduce errors and improve processes and performance; manages the development of credentialing policies and procedures, including primary source-verification activities; works with Senior Leadership to assure that resources are prioritized to meet provider and corporate needs.
Minimum Education Required
Bachelor's Level Degree
Bachelor's Degree and ten years or more of equivalent education/experience in health-related field; experience in health plan/managed care experience, including operations and servicing, provider/hospital/ancillary contracting and network development, and management experience, claim payment operations, provider reimbursement methodologies, managing teams and external vendors. Possesses excellent critical thinking and problem solving skills as well as negotiation skills with businesses; demonstrates strong leadership trait. Strong collaboration and communication skills are a requirement. Experience in health plan or health insurance preferred.