MANAGER, NETWORK DEVELOPMENT at HealthSmart in Irving, Texas

Job Description:

About HealthSmart

HealthSmart is the premier provider of customizable and scalable health plan solutions for self-funded employers. We reduce costs and improve outcomes, all the while treating our health plan members with dignity and respect. But that's just the beginning of our story - We make differences in peoples' lives every single day!

Our HealthSmart team understands the difference we make when treating others with dignity and respect, which is why we embody our mission by promoting a diverse and inclusive culture.

We're a company of innovators.

We deliver health benefit plans and solutions to provide worry-free, self-funded plan administration, quality coverage, and innovative care.

We provide care management services that change lives and helps employers and members take control of healthcare costs.

HealthSmartRx Solutions delivers extremely attractive pharmacy benefits with an Rx discount program.

Our Network Solutions group offers national, comprehensive provider networks to provide member access to the right care.

HealthSmart Casualty Claims Solutions leverages technology, robust information and unmatched experience to deliver innovative casualty claims management solutions with outstanding results.

We offer business intelligence and web-based reporting. Plus, we offer a variety of health and wellness initiatives and even onsite employer clinics.

POSITION SUMMARY
At HealthSmart, the Manager of Network Development will manage the network development activities within an assigned market area and to ensure that network development goals and standards are met within that region, including the implementation and negotiation of all provider contracts.

Required Skills and Experience

• Bachelor's Degree required


• Ability to travel 50% of the time


• Proven ability to work remotely


• Working experience in Provider Networks


• Successful track record of developing Provider Networks

Essential Functions Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

• Develops and executes regional network development strategies (goals/work plan) for assigned market area(s); manages activities and monitors outcomes to ensure that established goals are achieved


• Conducts contract language and rate negotiations with hospital, facility, ancillary and professional providers within the region to ensure the network development goals are met


• Responsible for building and maintaining highly functional relationships with appropriate provider contacts within the region


• Responsible for the provider contracting process for assigned region


• Coordinates the implementation of the terms and conditions of all professional contracts and select facility contract for the assigned region


• Assists in determining network development needs within the region


• Ensures that appropriate analysis of cost and utilization data is performed in order to understand the financial and operational impact of contractual proposals by assisting with Business Intelligence for rate analysis or performs appropriate rate analysis with Contract Modeling Analyst


• Reviews all rates and language prior to being submitted to senior 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


• Assists Sales and Marketing in the preparation of requests for proposals and supports membership growth through network development, as appropriate


• Ensures that relevant data is gathered and monitored regarding the provider community within the region, such as hospital financial and operational performance and other competitive information


• Maintains a working knowledge of payer benefit packages, policies and procedures and interprets this information to contracted providers


• Meets corporate contracting goals including timing, term, conditions and financial performance


• Must demonstrate the following Capabilities: Leadership, Collaboration, Adaptability, Innovation and Creativity

Physical Requirements

• While performing the duties of this job, the employee is frequently required to sit, talk, and hear.


• The employee is occasionally required to walk; use hands and fingers to feel, handle, or operate objects, tools, or controls; and reach with hands and arms.


• The employee must occasionally lift and/or move up to 30 pounds.


• Specific vision abilities required by this job include close vision and the ability to adjust focus.


• The work is performed primarily in an office setting.


• The noise level in the work environment is moderate.

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position

HealthSmart provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.