Correct Care Solutions Provider Network Development Manager in Nashville, Tennessee

Overview

Our Network Development Manager is responsible for assisting with the development, management, and performance of the CCS network of preferred providers. The Manager will align with operations and ensure CCS has access to the best qualified out-of-facility providers at the lowest cost in locations where needed.

Qualifications

Education:

  • Bachelor’s degree in related field or equivalent experience.

Experience:

  • At least five (5) years of Managed Care/Healthcare contracting experience with five (5) or more years of experience working with Managed Care contract terms and reimbursement methods.

  • Position requires strong skills in MS WORD, EXCEL, PowerPoint, and Outlook.

  • Excellent analytical, leadership, communication and presentation skills.

Licenses/Certifications:

  • None required.

Responsibilities

  1. Develops and continually optimizes the CCS provider network.

  2. Conducts contract language and rate negotiations with hospital, facility, ancillary, and professional providers to ensure network development goals are met. Recommends market fee schedules and rate targets that are competitive and within CCS contract requirements.

  3. Maintains a working knowledge of industry, national healthcare reform, national coding initiatives, licensure and accreditation, payer benefit packages, policies and procedures, and interprets this information to contracted providers.

  4. Develops and continually optimizes the CCS private provider network for out-of-facility healthcare services to minimize cost and maximize patient access.

  5. Through both in-house referrals and data analysis identifies network gaps or optimization opportunities.

  6. Ensures relevant data regarding the provider community within the region is gathered and monitored; data may include hospital financial, operational performance, and other competitive information

  7. Reviews and proposes rates and language prior to being submitted to management for approval, ensuring that provider network contracts and amendments are finalized in compliance with corporate policy, state licensure requirements, state mandates, and regulatory agencies. Obtains internal approvals for contracts in compliance with CCS policies.

  8. Ensures contracts are loaded into the various systems timely and accurately by auditing the contract and demographics after data entry.

  9. Ensures contracts are maintained in the CCS master database of provider contracts including terms and fee schedules.

  10. Assists with client presentations and the preparation of Requests for Proposals and supports membership growth through network development, as appropriate.

  11. Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.

  12. Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.

  13. Must be alert at all times; pay close attention to details.

  14. Must be able to work under stress on a regular or continuous basis.

  15. Up to 30% Travel.

  16. Perform other duties as assigned.

CCS is an EOE/Minorities/Females/Vet/Disability Employer

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Job 18-47960

Location TN, Nashville

Facility Correct Care Solutions

Type Regular Full-Time

Shift Day