Dir, Network Management

Company: Western Dental
Location: Orange
Posted on: November 25, 2022

Job Description:

Responsible for managing the Regional dental and vision network field team. - The network team is focused on all activities necessary to develop and maintain the provider networks and the financing system. The financial system includes overseeing the Special Arrangement Tracing report, the capitation report and membership assignment. -Network management includes quarterly evaluation of network adequacy for both dental and vision, evaluating and approving cost-effective arrangement to ensure coverage. - Responsible for providing data to respond to RFPs, Quality Assessment Reviews, to the manager is responsible for project management, metrics and internal communication to the Plan department management team

• Directs a regional network management team for dental and vision
• Responsible for strategic development and management for a regional dental and vision network in the commercial and government markets
• Develop and execute strategies to comply and improve network efficiency
• Evaluate state compensation for Medicaid and Medicare Programs to develop competitive reimbursement schedules
• Responsible for the network sections of key RFP proposals to identify and develop strategic innovative performance-based programs
• Develop policies, procedures and standards for department and interdepartmental activities and processes
• Oversee all team regional dental and vision projects
• Developed a strategic and competitive network for all Premier's markets - commercial and government.
• Established network goals and objectives as defined by state contract requirements
• Trending and Analysis - Key component to ensure that the network was cost effective and in line with health care cost estimates
• Developed and established provider performance standards to align with financial performance of contracts
• Oversee provider network training and education on Medicaid and Medicare guidelines and requirements
• Directed, evaluated, and identified training needs for dental and vision network managers
• Ensured that the team is focused on facilities identified by the Quality Management Committee to meet Value Based Performance requirements
• Directs team on specific State compliance requirements
• Develop relationships with state dental associations, to identify and meet regional and local provider concerns
• Developed and implemented policies and procedures to manage the business, monitor healthcare costs, meet regulatory guidelines, and effectively renegotiate contracts
• Made recommendations to the V.P. of Plan Benefits regarding full-risk plans and how to monitor and control health care costs
• Report to the V.P. of Plan Benefits on status of the network, changes in current processes, how to increase cost savings, and how changes would affect the network
• Manager, oversee and create Provider outfacing documents, i.e. notification templates, Provider Manual, Newsletters, etc.
  
• Bachelor's degree preferred
• Strong negotiation and reasoning skills
• Thorough knowledge of managed health care:
• Reimbursement mechanisms
• Quality improvement initiatives
• Ability to create and present solutions to specific problems
• Thorough knowledge of government agency and commercial health plans
• Ability to manage multiple projects
• Meet goals
• Meet timelines
• Ability to conduct trainings to small and large groups
• Experience working with Account Executives and the ability to present products to Brokers in a formal and in-formal environment
• Minimum of 5 years' experience in Healthcare
• Travel 50%CADP Auditor preferred - -

Keywords: Western Dental, Orange , Dir, Network Management, Executive , Orange, California