Director, Network Development – Mid Atlantic Region

🕒 vor 8 Tagen

🌲 North Carolina, Pennsylvania, +1 weitere Bundesländer – Remote

🌲 North Carolina – Remote 🔔 Pennsylvania – Remote ⚔️ Virginia – Remote

💵 $175.000 - $200.000 / Jahr

⏰ Vollzeit

🔴 Experte

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Curative

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501 - 1000 Mitarbeiter

Gegründet 2020

🏥 Gesundheitswesen

🛡️ Versicherung

Healthcare • Insurance

Curative ist ein arbeitgeberzentriertes Krankenversicherungsunternehmen, das einen innovativen Gruppengesundheitsplan anbietet, der sich durch Erschwinglichkeit, Engagement und Einfachheit auszeichnet. Ihre Pläne versprechen $0 Zuzahlungen im Netzwerk, $0 Selbstbehalte und eine einheitliche, wettbewerbsfähige monatliche Prämie, zusammen mit einem breiten Anbieternetzwerk, Telemedizin, einem umfangreichen $0-bevorzugten Rezeptformular, Betreuungsnavigatoren und der Curative Cash Card, um Selbstkosten in vielen Bereichen zu eliminieren. Curative richtet sich an Arbeitgeber und Makler, während es den Mitgliedern Ressourcen wie einen Baseline-Besuch, Pflegeprogramme, Online-Portale und Apothekendienste bietet und ein A- Rating von AM Best sowie die HITRUST r2-Zertifizierung besitzt.

Beschreibung

• Manages contract negotiations with Major Health System and large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands • Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations • Proactively builds relationships that nurture provider partnerships to support the local market strategy • Initiates, nurtures, and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing • Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position • Identify and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreements • Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms • Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities. • Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues. • Manages key provider relationships and is accountable for critical interface with providers and business staff • Coach and support newer team members on strategies and approaches to successful negotiations • Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape • Partner with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity • This position assumes and performs other duties as assigned.

🎯 Anforderungen

• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen • Experience with complex Hospital / Health Systems, Large Physician Groups and Ancillary provider contracting and negotiations • Experience negotiating delegated credentialing agreements • Experience in developing and managing key provider relationships including senior executives • Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners • Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models • Team player with proven ability to develop strong working relationships within a fast- paced organization • The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations • Customer centric and interpersonal skills are required

🏖️ Vorteile

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.) • $0 copays and $0 deductibles (with completion of our Baseline Visit ) • Preventive and primary care built in • Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged) • One-on-one care navigation • Chronic condition programs (diabetes, weight, hypertension) • Maternity and family planning support • 24/7/365 Curative Telehealth • Pharmacy benefits • Comprehensive dental and vision coverage • Employer-provided life and disability coverage with additional supplemental options • Flexible spending accounts • Flexible work options: remote and in-person opportunities • Generous PTO policy plus 11 paid annual company holidays • 401K for full-time employees • Generous Up to 8–12 weeks paid parental leave, based on role eligibility.