THIS POSITION IS POSTED EXTERNALLY BUT IS ONLY FOR QUALIFIED TRIWEST INTERNAL EMPLOYEES.
Direct Contracting Manager at TriWest Healthcare Alliance
Taking Care of Our Nation’s Veterans.
It’s Who We Are. It’s What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!
Our job is to make sure that America’s heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.
Are you our next Direct Contracting Manager?
Responsibilities:
TriWest Direct Contracting Manager:
Develops and maintains provider relationships within designated state/territory that TriWest is responsible for direct contracting. Manages network development activity with network providers and recruits new providers to meet business needs.
Develops hospital, physician and ancillary service agreements, ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region.
Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives.
- Provides legendary service and support to maintain strong relationships with internal and external customers.
- Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics.
- Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to Sr. Manager for inclusion in overall network development plans.
- Regularly reviews and determines appropriate network access and development and makes recommendations to support network build activities.
- Provides regular updates to the Sr.Manager and/or VP regarding provider network development, management, and access for assigned areas.
- Monitors and ensures resolution of routine and escalated provider issues
- Communicates information regarding market needs, competition, and industry trends to management team.
- Provides training and development to team members.
- Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
- Maintains client confidence and ensures confidential information is protected.
- Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
- Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues.
- Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
- Provides development and training to Network Providers on changes and updates to TriWest processes and policies.
- Identifies issues for future educational seminars that are identified through provider interactions.
- Collaborates with Provider Education to incorporate these ideas in upcoming provider education materials and updates.
- Assists provider community with any claims issues, including Electronic Media Claim filing problems, reimbursement issues, and billing questions.
- Answer general questions on credentialing process and technical aspects of the Program.
- Monitors and responds to network shortfalls within region..:
- Demonstrate and maintain current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
- Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement
- Collaborate closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes
- Head or participate in projects and committees assigned by Sr. Contracting Manager or Vice President.
- Performs other duties as assigned.
- Regular and reliable attendance is required.
Qualifications:
Are you qualified?
- Are you a Veteran, family member of a Veteran, a friend of a Veteran, or passionate about helping Veterans?
- Do you have a Bachelor’s degree in Business, Health Care Administration or equivalent experience
- Do you have Experience with provider contracting and negotiation experience?
- Do you have 5 years of experience in a Managed Care environment?
Preferred
Do you have Experience in provider contracting for government programs and/or commercial lines of business?
Do you have experience establishing relationships and reside in the market for which the position is located?
Do you have Management experience in the healthcare industry?
Do you have Experience in utilizing a contract management system to manage contracting workflow?
More about Working at TriWest Healthcare Alliance
We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, dental and vision coverage
- Generous paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
Equal Opportunity Employer
TriWest Healthcare Alliance is an equal employment opportunity employer. All qualified applicants are considered for employment, without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic made unlawful by applicable federal, state, or local laws.
Are you ready to make a difference in the lives of our nation’s heroes?
Source: Indeed.com
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