Director Network Development- Facility&Ancillary/Healthplan/Specialty at Southwestern Health Resources CIN in Pittston, Pennsylvania

Job Description:

Southwestern Health Resources Clinically Integrated Network (SWHR CIN), is hiring for a Director of Network Development- Ancillary, Healthplan and Specialty Network.

The Director will oversee the development, supervision and execute a contracting strategy for the Facility and Ancillary Network, Specialty Network and Healthplan. Including direct management of operational ancillary, specialty and healthplan network objectives. This position will report directly to the Senior Director, SWHR CIN Network Development.

Location: Hybrid-some remote and some onsite in the corporate offices in Farmers Branch, TX

Core Hours

• Full time, Monday through Friday, 8am-5pm

Job Duties

Develop, manage and support the SWHR Ancillary, Specialty and Health Plan department roles.
Design monthly productivity target plans that align with the CIN development and contract strategy for CareNCare, Ancillary and Specialty Network and communicate this strategy to Senior Leadership. Oversee assignment of productivity targets to ensure goals are met. Promote and support activities that ensures SWHR meets organizational metrics.

Support Physician Network quality and financial objectives as related to Ancillary and Specialty:
Supervise contract negotiations and renewals, including assessment of market trends and competitive positions relative to rate
Assure that all contracts follow physician network governance process and structure
Develop and support physician network strategies to improve provider and member satisfaction
Support assigned physician network work targets related to quality, cost and innovation

Develop and execute operational objectives related to contracted health plan utilization management, provider relations and member services departments.
Oversee and lead CMS initiatives related to Facility and Ancillary Network.
Oversee and develop strategies related to Specialty Provider Engagement including outreach and member satisfaction.

Promote, maintain and manage SWHR Network and team goals and objectives through effective hiring, performance management, coaching and career development.
Ensure provider network contracts and amendments are finalized in compliance with corporate policy, and if applicable, state licensure requirements, state mandates, regulatory agencies, and/or federal and CMS regulations.
Responsible for tracking contract negotiations using management tools, oversee creation of reporting and design of specific action plans for negotiations that are off-track.
Perform other related duties as assigned.

Education
Bachelor's Degree in relevant field required

Experience
8 years to include provider or health plan contracting, network development, business development, and/or strategic planning. Must also include a minimum of five (5) years of experience in a management/supervisory capacity.
Demonstrated experience with hospital, large physician group and ancillary contracts including capitation and risk-sharing arrangements required

Skills
Strong analytical and reasoning abilities.
Strong contract negotiation skills.
Demonstrated ability to handle sensitive and complex issues.
Must have strong knowledge of SalesForce, MS Word, and MS Excel.

Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health and UT Southwestern, two of the region's leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N' Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region.

The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care. In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation's leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017.

At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.

We invite you to learn more about us at www.southwesternhealth.org.

Let's move healthcare forward - together.