Develop new programs to support the strategic direction of the organization.
Organize programs and activities in accordance with the mission and goals of the organization.
Create and managing long-term goals
Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
Establish internal standards for the development and maintenance of the provider network to ensure adequacy and accessibility of contracted services
In conjunction with leadership, assist in the development of strategies for growth and branding throughout the provider network.
Develops and deploys strategic network planning tools to drive Provider Services and Contracting Strategy across the enterprise.
Develops and implements a tracking processes that ensure providers complaints and issues are mitigated in a reasonable time period(SLA)
Facilitates strategic planning and documentation of network management standards and processes
Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
Serves as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution
Operates with general supervision, elevating unusual situations to management as required.
Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controls
Coach, provide feedback and guide the network team members
Works on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management.
Serves as a communication link between professional providers and the company.
Conducts more complex negotiations and drafts documents.
Provide leadership in evaluating opportunities to expand or change the provider network to meet the customer needs
Work with the relevant departments to understand service gaps and opportunities for improvement with existing network providers
Develop staff capability, knowledge, skills and understanding of the Operations support operations and business needs. Ensure all SOP being adhered to and documented in a timely and accurate manner.
Manage and maintain the network, as well as˙network performance monitoring
Responsible for the monitoring of Quality of Service to our network clients and surveying the providers
Establish a set of KPIs and champion the development of a dashboard to monitor network team in terms of quality
Prepares financial projections and conduct analysis reports
Manage unit cost budgets, target setting, performance reporting and associated financial models
Conduct ongoing network analysis reports, monitoring network against the member demographics, utilization and other targeted population indicators
evaluations and monitoring reports of staff performance (KPIs reports)
Motivate employees and ensuring a focus on the team goals.
Accountable for achieving the support operations services related target Key Performance In
