Director Network Management

Position Summary:

The Director of Network Management is responsible for network growth and development, physician recruitment and contract negotiations. The Director will manage a team of Network Managers, monitor operational and fiscal performance, membership growth, contractual compliance, marketing, business development, provider contracting, provider relations and provider education.

The Director is also responsible for working in collaboration with the Senior Vice President of Regional Operations & the Vice President of Network Management to identify, develop and oversee opportunities for growth within a specified region/campus. In addition, this individual coordinates or performs special projects/activities as delegated by the Senior Vice President of Regional Operations. The individual in this position will also be a strategic leader for aligning business development opportunities with the organization's goals & mission.

Essential Duties and Responsibilities include the following:

• Responsible for working collaboratively with the Senior Vice President of Regional Operations, the Vice President of Network Management and Medical Management team to ensure network growth and development initiatives are being met and networks are operating within budget.
• Responsible for the oversight of negotiations of provider contractual agreements by network managers during Primary Care, Specialty and Ancillary recruitment projects.
• Serves in a leadership capacity in strategic initiatives, special projects, business development or network planning.
• Coordinates or performs special projects/activities as delegated by Senior Vice President of Regional Operations & Vice President of Network Management
• Assists with identification of potential providers within targeted area and ensure non-participating providers who are essential to the network are recruited.
• Responsible for the oversight of Network Managers for assigned campus/region
• Responsible for the oversight of assigned network(s) to ensure network provider deficiencies are being resolved.
• Works closely with assigned Network Support staff and Medical Management counterparts to ensure network needs/changes are being effectively addressed and communicated both internally and externally.
• Work closely with Regional Medical Directors & other leaders within organization.
• Assist with the resolution of provider grievances and appeals in accordance with contractual requirements; Health Plan requirements, and corporate policy.
• Assist with the resolution of claims issues by working with appropriate internal departments.
• Ensure contract compliance and adherence to DMHC, DHCS, CMS and other regulatory requirements.
• Ensure accurate and timely data reporting requirements are being met including eligibility and capitation reports, risk sharing, risk pools, claims timeliness, pharmacy utilization, bed days utilization, encounter data and audit compliance agencies as required by company policy and contracting HMOs.
• Perform on-site visits (as required) to physicians, physician groups, hospitals and ancillary providers.
• Facilitate the quarterly Joint Operations Meetings and Town Halls with contracted providers and office staff.
• Follow and adhere to Employee policies and procedures.
• Maintain patient confidentiality and ensure HIPPAA compliance is observed at all times.
• All other duties as directed by management.
• Some evening hours required for facilitation of physician events such as Town Halls or Physician meetings.

The pay range for this position at commencement of employment is expected to be between $95,000 - $100,000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and / or Experience:

• Must have at least 4-6 years supervisory experience in provider relations & physician recruitment
• Minimum 3-5 years of experience in negotiating professional and ancillary provider contracts or equivalent experience to support negotiations
• Effective oral, written and presentation skills
• Advanced knowledge of contracting principles/tools and various managed care reimbursement methodologies for Medicare, Medi-Cal and Commercial programs/products
• Effective oral, written and presentation skills
• Effective interpersonal skills
• Financial and analytical skills a plus
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
• Bachelor's Degree preferred or equivalent experience