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Senior Director Provider Account Management, Geisinger Health Plan (work from home Pennsylvania resident)
Location: Danville, Pennsylvania
Type: Full Time
Internal Number: R-41284
Provides overall accountability for Account Management functions including negotiation and ongoing provider network servicing. Provides leadership in the development of departmental strategic plans, budgets, and forecasts. Provides guidance and assistance to management in the administration and execution of strategic goals. Develops overall strategy and goals in conjunction with management and leadership, by providing continuous, innovative leadership and direction to the development and ongoing monitoring and maintenance of relationships. Shapes and executes development of preferred provider relationships between the Health Plan and network providers/ACOs. Develops and manages initiatives that drive expanded business opportunities, programmatic growth and innovation.
Develops positions and insight documents that articulate the pros and cons of different courses of action/options for potential or existing preferred provider relationships.
Develops formal strategies to maximize the success of existing or new potential preferred provider relationships.
Conceptualizes, builds and launches programs through preferred providers and network, from product conception to go-to-market plans, ensuring the best product experience for preferred providers in the network.
Manages the development and maintenance of the health plan provider network to include selection of providers and either direct or oversight of negotiation/renegotiation of contacts with providers.
Manages contractual relationship between Geisinger Health Plan and multiple partnerships.
Oversees the Unit Cost position with all contracted providers.
Develops and drive the strategy, solutions and growth of the health plan and accountable for formulating the long-term strategy and building/integrating the provider network
Mobilizes and manages teams of individuals charged with executing strategies.
Oversees the management and development of the provider network to meet Strategic System goals, Sales and Marketing goals and projections, including:
Negotiation or oversight of negotiation of complex contracts with hospitals and preferred provider groups.
Development of the next generation of Pay for Performance
Determination of the most appropriate size, composition and geographic distribution to meet all regulatory standards, cost optimization and quality strategies and member needs.
Ensures communication across all functional areas.
Ensures adherence of contractual commitments.
Participates in the design, development, and implementation of automated reporting mechanisms that are specifically focused on the overall unit cost performance of the department and are easily utilized by the account management staff.
Develops and implements cost, quality and reimbursement strategies into strategic network development plans to ensure development of a high performing physician network and preferred provider relationships.
Develops and leads the re-engineering of current processes throughout the department with a focus on maximizing efficiencies and promoting automation.
Ensures the ongoing satisfaction and long-term retention of providers. Develops and adjusts recruitment strategies as necessary. Facilitates ongoing problem solving and serves as a resource to interpret and clarify contract related questions and administrative issues.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
Bachelor's Degree-Related Field of Study (Required), Master's Degree- (Preferred)
Minimum of 10 years-Related work experience (Required), Minimum of 5 years-Managerial/Supervisory (Preferred)
Certification(s) and License(s)
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 1...3 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.