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Director, Network Operations

Chicago, Illinois Apply Now Job ID 1174208 Category Network Development & Contracting Organization Centene Corporation Schedule Full-time
Description:

Position Purpose: Oversee all network management related activities for existing providers ensuring the business unit is meeting state and customer required network standards for accessibility and availability.

  • Collaborate with existing providers to improve clinical effectiveness and achieve the best possible outcomes for members
  • Oversee network management team and related activities to identify service delivery needs or pain points, outcomes tracking, special expertise, training needs and pilot opportunities
  • Negotiate contracts with hospitals, physician groups and ancillary service agreements
  • Ensure the successful implementation of evidence-based practices in the provider community
  • Serve as a resource for information and training to providers
  • Oversee provider claims projects including ensuring smooth claims submission
  • Collaborate with internal departments to ensure provider satisfaction and recommend improvement opportunities when needed
  • Review, investigate, and resolve inquiries regarding provider services’ issues and ensure accuracy of provider service delivery reports
  • Monitor operational and financial performance of agreements using results to guide future negotiations
  • Identify trends and develop solutions to obtain overall operational and financial goals
  • Review contracts annually to ensure compliance with State, Federal and Centene current guidelines

  • Qualifications:


    Education/Experience: Bachelor's degree in Business Administration, Health Care Administration, or related experience. 7+ years of combined network development, provider relations, or contracting experience. Knowledge and understanding of managed care regulations for Medicaid. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

    License/Certification: Current state driver’s license.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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