Manager of Network Provider Development – Healthcare

Manager of Network Provider Development – Healthcare

AIC is seeking a Manager, Network Development will design and implement successful development

activities for the recruitment, contracting and retention of providers in support of the Kidney

Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Graduated, Professional,

and Global Models- in which dialysis facilities, nephrologists, and other health care providers

form ESRD-focused accountable care organizations to manage care for beneficiaries with ESRD

– by adding strong financial incentives for health care providers to manage the care for

Medicare beneficiaries with chronic kidney disease (CKD) stages 4 and 5 and ESRD, to delay the

onset of dialysis and to incentivize kidney transplantation.

Responsibilities

• Partners with Senior Management and other departments to build a comprehensive

network strategy to support market growth.

• Builds, refines and manages network of preferred external nephrologists and dialysis

providers

• Performs in-depth analyses on the market place to identify current and future needs in

Healthcare and current performance of provider network

• Maintains knowledge of medical trends, cost drivers and cost saving opportunities.
• Leads the referrals team and process (review, process, authorization, follow-up and

coordination with providers)

• Implements contract terms and conditions.
• Works with various departments (operations, legal, and client management) to ensure

contracts meet operating, financial and legal standards.

• Ensures compliance with CMS/CMMI programs

Requirements

• Undergraduate Degree, Masters highly preferred
• 4+ years of experience in a network management-related role, such as contracting or

provider services

• Prior experience in a health plan, managed care organization, medical group physician

office or IPA setting preferred.

• In-depth knowledge of Medicare Innovation Models (CMMI).
• Working familiarity with various managed healthcare provider compensation methodologies, including but not limited to: fee-for service, capitation and various forms of risk, ACOs, etc.
• Project management experience.

Skills

• Excellent verbal, written communication and presentation skills
• Strong analytical and strategic skills required
• Metrics driven
• Ability to manage multiple priorities
• Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint