What are the responsibilities and job description for the Manager, Provider Network Development position at Triwest Healthcare?
We offer remote work opportunities (AK, AR, AZ, CA,
- CO, FL,
- HI, IA, ID,
- IL, KS, LA, MD,
- MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA / DC,
- WA, WI & WY only).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
In partnership with the Director of Network Development (DOND) provide overall management of the direct contracting. Manager will work with DNOD and Direct Contract Managers (DCMs) to develop, and maintain provider relationships within designated state / territory or provider types that TriWest is responsible for direct contracting. Responsible for staff recruiting, staffs new hire orientation and ongoing training, managing and allocating resources and staff to support network adequacy. Develops hospital, physician and ancillary service agreements, ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives.
Education & Experience
Required :
o Bachelor's degree in Business, Health Care Administration or related field or equivalent experience
o 5 years experience in provider contracting
o 3 years management / supervisory experience
Preferred :
o 2 years VA or other government healthcare program experience
Key Responsibilities
o Serve as the focal point for all network contracting issues.o Contribute to and assist DOND with managing department budget, goals, and staff to promote high levels of customer satisfaction, streamline processes, and improve efficiency.o Demonstrate and maintain current knowledge of all contracting, credentialing, reimbursement and operational policies.o Maintain current knowledge of TriWest initiatives, operations, and goals. o Collaborate closely with other department leadership, staff, and leadership / staff in other TriWest departments on process improvement to promote service level improvements.o Oversee development of content and monitor compliance of all reports related to the adequacy of the provider network to include at a minimum the Network Adequacy Report, Network Access Report, Network Referral Report and Network Claims Report.o Train new employees in job responsibilities, to include TriWest and departmental policies and procedures, provider education material, service standards, systems training, and escalated issues resolution processes within specified time frames.
o Complete annual performance appraisals for direct reports and annual goal-setting with staff.o Monitor productivity, quality and quantity of work performed by staff, including annual visits, escalated issue resolution, documentation of shortfalls in all states, and compliance with TriWest and departmental policies, etc.o Engage in regular staff development activities to include meetings with each staff person (held telephonically for remote staff) at least monthly, training with each new staff member, and ongoing training as needed. o Provide mentoring, coaching, and work collaboratively with staff to establish goals. Also when required, develop appropriate performance improvement plans.o Consistently recognize staff by using the rewards and recognition program.o Head or participate in various projects and committees assigned by leadership.o Ensure TriWest and departmental policies and procedures are developed and followed.
o Provides legendary service and support to maintain strong relationships with Network Subcontractors.o Regular and reliable attendance is required.
Competencies
Communication / People Skills : Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.
Computer Literacy : Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Empathy / Customer Service : Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.
Independent Thinking / Self-Initiative : Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.
High Intensity Environment : Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Organizational Skills : Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.
Team-Building / Team Player : Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills : Provider relations / contracting experience; Working knowledge of Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare), and the insurance industry; Diplomacy and negotiation skills; Financial analysis skills to analyze contractual reimbursement; Project management skills; Presentation skills; Proficient with Excel
Working Conditions
Working Conditions :
o Favorable working conditions in a climate controlled office space.
o Must be able to travel (locally or distant with overnight stays) a minimum of twenty (20) percent and maximum of seventy-five (75) percent of the time.
o Must be able to work under stressful conditions.
o Must be available to cover any work shift.
Company Overview
Taking Care of Our Nation's Heroes.
It's Who We Are. It's What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!
Our job is to make sure that America's heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes :
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
Salary : $95,000 - $122,000
