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Market Network Manager

Company: Project Titan, LLC
Location: Oklahoma City
Posted on: February 22, 2021

Job Description:

ArchWell Health is re-imagining the practice of primary care. We are putting the relationship between member and physician at the center of a value-based model focused on outstanding member experience, improved access, and better outcomes. In our medical clinics, we provide comprehensive primary care for senior adults with traditional Medicare and Medicare Advantage plans, focused on delivering improved quality, better member experience and lower total cost of care.-- Job--Summary: Our care team is extended by the clinical support team, creating a seamless experience for our members to ensure they are cared for and coordinate the care needed outside of the clinic. The Market Network Manager is a critical role to create the infrastructure and processes needed to manage this referral network. Partnering with the broader market leadership team, the Market Network Manager is responsible for building a comprehensive network strategy to support market growth. This is accomplished by building a high-performance network of preferred external specialists and facilities. The Market Network Manager will manage a team across all centers in their region, ensuring the day-to-day referrals and diagnostic orders for ArchWell Health members to see specialists outside the clinic are handled with care and in a timely manner. S/he should be well-versed in data-driven approaches and systems, bringing analytical rigor to all aspects of the role. Duties/Responsibilities:

  • Oversight of network operations, ensuring a high-performance network is established and referrals are systematically & seamlessly coordinated for ArchWell Health members
  • Build the provider and specialty network in market through the lens of key performance indicators and medical economics and trend data; use this analysis to create a long-term network strategy
  • Identify ways that health plan provider networks can be diversified to accommodate current and future client needs, improve quality, and reduce costs of service
  • Negotiate contracts with specialists, hospitalists, and other provider groups to ensure greatest continuity of care for members; work cross-functionally with various departments to ensure contracts meet operating, financial, and legal standards
  • Oversees compliance with government programs such as Medicaid and Medicare for all contracting and network development purposes
  • Manage, coach, and mentor the referral team of care coordinators; in addition, provide training and input for market staff on network and referrals strategies to ensure highest level of member satisfaction
  • Development and oversight of referrals processes, including review, authorization, follow-up, and coordination with providers, generating regular referral workflow and analysis reports
  • Manages provider network costs, by ensuring appropriate coverage and minimizing extra payment costs
  • Employ a data-driven approach to monitor and evaluate the network for continuous improvement Required Skills/Abilities:
    • Experience with a payer or provider building provider networks is preferred
    • Knowledge of Medicaid/Medicare plans, federal, and state legislation
    • Excellent critical reasoning, decision-making, and problem-solving skills --
    • Experience building, managing, and coaching a team, with a focus on customer service
    • Experience with claims/quality reports and analytical software packages
    • Must possess a high degree of emotional intelligence and integrity; driven and focused work ethic
    • Strong communicator that is customer-oriented
    • Self-starter with the ability to think creatively and work effectively
    • Ability to travel on occasion for company meetings, contract negotiations, and vendor management
    • Team oriented and entrepreneurial Education and Experience:
      • Bachelor's degree in Business Administration or a closely related discipline required; Master's degree preferred
      • A minimum of 5 years building provider networks
      • A minimum of 3 years of management experience
      • Experience in provider contract negotiations, including FFS, capitation models, and pay for performance models is preferred
      • Excellent analytical, strategic thinking, and creative thinking skills
      • A passion for mentorship and team-development
      • Embodies and serves as a role model of ArchWell Health's Values:
        • Be compassionate
        • Strive for excellence
        • Earn trust
        • Show respect
        • Remain resilient
        • Do the right thing and do it with passion The following questions are entirely optional. To comply with government Equal Employment Opportunity and/or Affirmative Action reporting regulations, we are requesting (but NOT requiring) that you enter this personal data. This information will not be used in connection with any employment decisions, and will be used solely as permitted by state and federal law. Your voluntary cooperation would be appreciated. Learn more . Invitation for Job Applicants to Self-Identify as a U.S. Veteran
          • A "disabled veteran" is one of the following:
            • a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
            • a person who was discharged or released from active duty because of a service-connected disability.
            • A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
            • An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
            • An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVE
              I AM NOT A PROTECTED VETERAN
              I DON'T WISH TO ANSWER Voluntary Self-Identification of Disability Voluntary Self-Identification of Disability Form CC-305
              OMB Control Number 1250-0005
              Expires 5/31/2023 Why are you being asked to complete this form? We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years. Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp . How do you know if you have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:
              • Autism
              • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
              • Blind or low vision
              • Cancer
              • Cardiovascular or heart disease
              • Celiac disease
              • Cerebral palsy
              • Deaf or hard of hearing
              • Depression or anxiety
              • Diabetes
              • Epilepsy
              • Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
              • Missing limbs or partially missing limbs
              • Nervous system condition for example, migraine headaches, Parkinson's disease, or Multiple sclerosis (MS)
              • Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression Please check one of the boxes below: YES, I HAVE A DISABILITY, OR HAVE A HISTORY/RECORD OF HAVING A DISABILITY NO, I DON'T HAVE A DISABILITY, OR A HISTORY/RECORD OF HAVING A DISABILITY I DON'T WISH TO ANSWER PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Keywords: Project Titan, LLC, Oklahoma City , Market Network Manager, Executive , Oklahoma City, Oklahoma

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