Provider Network Development Manager-Data & Analytics

Competitive Compensation & Benefits Package!  

Position eligible for – 

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details. 

Location:  Remote option; Available for any of our office locations

Projected Hiring Range:  Depending on Experience 
Closing Date:  Open Until Filled

Primary Purpose of Position: The Provider Network Development Manager – Data and Analytics is responsible for ensuring that the agency meets the Network adequacy standards outlined by DHHS and analyzes network performance measures directly related to the network development/network access plan; works across the agency to capture initiatives and develop reports that support the illustration of the adequacy of the network; work collaboratively with providers, community stakeholders, and assesses opportunities for provider recruitment that enhances member access and increases quality in the provider network. The Provider Network Development Manager – Data and Analytics applies project management skills and leads a team of Provider Network Development specialists and/or Provider Network data analysts to carry out these objectives. This position requires work throughout the organization and requires a high level of diplomacy and tact. This position will interface with internal data governance to ensure accurate data for network adequacy and reporting on a regular basis. This position requires a dynamic, proactive approach to supervision, evaluation, and monitoring to align strategic initiatives and ensure compliance with contractual obligations and stakeholder expectations. The position is also responsible for development and management of a comprehensive value and performance based partnership strategies that enable tighter alignment between Partners and the Provider Network.  

Role and Responsibilities:  

• Provides project management for the company’s strategicobjectives, working with internal and external stakeholders todetermineproject definition and business requirements.
• Collaborates with other departments to deliver comprehensive and compelling recommendations for strategic initiatives for positive impact, including:
  • Identifyservice gaps and needs and acts to developsolutions;
  • Estimate cost(s) ofgaps;
  • Improve Population Health Outcomes through ensuring member access to services and that the network is available to servemembers;
  • Ensure service delivery isin accordance withbest practice models and clinical coverage policies.
  • Development of spectrum of valueandperformancebasedprograms across lines of business in alignment with core population health strategic goals
• Managesthe Network Adequacy requirements as defined by the State and developsreporting on a regular basis, either monthly or quarterly
• Developsreporting metricsand ensurestimelysubmission of required state reporting while workingcollaboratively across the organization toidentifydevelopment opportunities and illustrate network accessibility compliance
• Managesand ensures compliance ofthe Network AccessPlan asperState expectations
• Collaborates with health planregardingcompliance with network adequacy for all network requirements through data review,monitoringand collaboration. 
• Manages and/or leads the formation of requests for proposals and/or requests for information that directly support a robust provider network to ensure compliance with Network Adequacy Standards
• Manages the exception reporting for the purposes of compliance with the DHHS contracts
• Participates in input into the development of the memberand providerportalsfor the purposes of ensuring network adequacy and communicates across departments toidentifyneeds/gaps to improve the member/providerexperience in the network
• Manages and fosters solid collaborative relationships with external stakeholders and internal department leaders to developinnovative plans for special projects with detailed scopes of workandproject managementfor next steps.
• Assesses and manages risk throughout all aspects of the solution design and development and escalates as needed. Monitors progress, reports results/outcomes and adjusts as needed.
• Partnerswith legal and regulatory teams to ensure all approvals/regulationsobligations during the design phase have been met.
• Implement network engagement strategies linking strategic goals to the execution of network adequacy, network management, and the network access plan. 
• Interprets audit results,identifiestrends/patterns thatimpactservice/system quality, and then implements interventions aimed at addressing these trends/patterns with the outcome of services delivery tomembersat the highest degree of quality cross functional team activities.
• Experience recruiting andprocuringnew business opportunities to further develop and support the members in the network and close identified care gaps.
• Ensures all policies/procedures,network access/development plans are developed and implemented according to regulatory guidelines and standards, including state, federal and external review bodies.
• Oversees the maintenance and updating of the Provider Operations Manual by collaborating with each provider network team and ensuringthe state updates/corrections are included as needed. 
• Manages performanceand developmentspecialists charged with implementation of value-based contracts,ensuring network adequacy,andcollaboratingwith internal teamsto develop providerquality and performancemeasures.
• Ensure needed data is collected ona timelybasisand make recommendations for future improvements based on the data.
• Ensure the strategic goals of the organization are realized through thenetwork development cross function teamand report progress to PN Leadership and other audiences as indicated 
• Innovative in working collaboratively toidentifyopportunities for improvement in the lives of the members.
• Track and tend quality and financial goals to show performancerate.
• Demonstrated skills in oral and written communication

Knowledge, Skills and Abilities: 

• Considerable knowledge of the laws, regulations and policies that govern the program
• Exceptional interpersonal and communication skills
• Strong problem solving, negotiation, arbitration, and conflict resolution skills
• Excellent computer skills andproficiencyin Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint)
• Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws,rulesand regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements
• Ability to make prompt independent decisions based upon relevant facts
• Ability toestablishrapport andmaintaineffective working relationships
• Ability to act with tact and diplomacy in all situations
• Ability tomaintainstrict confidentiality in all areas of work
• Ability to prioritize work to meet deadlines
• Ability to present complex data and information to varying audiences, both internal and external, in a professional and clear manner
• Ability to applyappropriate judgmentand discretion in interpreting and reporting of data
• Strong project management skills
• Ability to summarize analytical results graphically and numerically in Microsoft Excel, PowerPoint, and ability toutilizevarious software products
• Ability to summarize analytical results graphically and numerically

Education and Experience Required: Bachelor's degree in health care administration, business administration, accounting, finance, or human services and five (5) years of experience in provider network management, health care insurance or other health care delivery setting. Three (3) years of supervisory, consultative or administrative experience. A combination of relevant experience may be considered in lieu of a bachelor’s degree. Must have ability to travel as needed to perform job duties. NC Residency is required.  

Education and Experience Preferred: Master’s degree and two (2) years’ experience in physical or behavioral health network operations, network management, provider relations, health care managed care, and/or healthcare payor systems. Three (3) years of supervisory, consultative or administrative experience. Experience analyzing and assimilating provider performance and healthcare outcomes data. Knowledge of patient/member/provider portals, reporting systems, and/or other reporting/data programs. NC residency is required. 

Licensure/Certification Requirements:  N/A