Job Summary:
The Network Operations Manager will be the central point of contact and support the crucial function of maintaining positive relationships with providers and plan partners to support all lines of business, with particular focus on Value-based, Shared Savings and Global Risk agreements, consistent with company goals and objectives. All this while enhancing the company’s presence, engaging with our network partners to improve performance and promote growth in the assigned markets considering the evolving competitive marketplace and provider landscape. This individual will work in a multi-disciplinary manner with payer partnerships, medical management, data analytics, and finance to ensure the alignment of goals and activities to advance InnovaCare’ s Vision and Mission.
Essential Functions:
Will work in concert with the Vice President of Payer Partnerships to promote Innovacare’s standing with plan partners. Serves as the Joint Operating Committee co-owner driving operational issues to the forefront.
Implement specific network strategies, including contracting relationships and performance monitoring for value-based incentive programs to deliver results measured through quality and affordability, and in pursuit of becoming the partner of choice in the market.
Oversees network functions to include Business Development; identifying, recruiting, analyzing and onboarding providers to Health Plan Rosters in addition to Panel Management efforts.
Education and Experience:
- College Degree with of 5 or more years in a progressively responsible leadership role focused on Managed Care, Practice Operations, running a Primary care office and/or running an MSO and understanding Health Plan operations.
- Has managed direct reports.
- Has had direct P&L responsibility.
Requirements And Knowledge:
- Good communicator, able to use Microsoft Office and basic computer skills
- Understands financials, medical analytics, provider contracting
- Knowledge of clinic policies and procedures, health care insurance practices and compliance
- Knowledge of CMS government regulations, billing, insurance, and coding requirements
- General knowledge of facility management, leases, and human relations regulations.
- Knowledge of computer systems, programs, and applications.
- General knowledge of compliance as it relates to CMS, AHCA and health care industry in general.
- Knowledge of medical terminology.
- Must speak English; Spanish is preferred but not required.
- Ability to assume broader organizational responsibilities as warranted.
Skills:
- Skill in written and verbal communication and customer relations.
- Able to manage and work with cross functional departments Self-motivation, organized, time-management and deductive problem-solving skills
- Maintain confidentiality and practice discretion and caution when handling sensitive information
- Effective communicator to executive level staff and external audiences balanced with strong interpersonal skills.
- Outstanding organizational and time management skills; proven abilities to manage multiple, often complex and sometimes competing, objectives, goals and other priorities to effective and efficient conclusion
- Creative problem solving and analytical thinking with a perspective of our health plan partners and members.
- Enterprise thinker with proven ability to develop relationships across all levels of the organization, as well as externally.
- Demonstrated results in being able to think strategically, anticipate future consequences and trends, and incorporate them into both a short-term and long-term organizational plan.
- A team player with experience in complex environments with the ability to build consensus among divergent interests and competing organizational needs. Capable of effectively messaging detailed value propositions to key stakeholders that blends operational know how and technical skills with market savvy and vision/strategy.
- Strong attention-to-detail Excellent communication and collaboration skills; exhibits professional maturity, confidence, and competence.
- Strong conflict resolution skills; proven ability to effectively and quickly achieve conflict resolution with affected parties and work in a cross functional environment
