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Regional Director of Network

  • R0009730
  • 1505 NW 167 St Miami Gardens, Miami, FL 33169

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Job Description
The National Director of Network Excellence is a new role for ChenMed. The individual will be responsible for training, developing, coaching and managing the company’s Market Network Directors in new market (i.e. Lakeland) and in designated turn-around markets (i.e. Chicago). The goal for these network directors is to ensure we maximize value and cost effectiveness though collaborative relationships with high-quality and value-based specialists, hospitals and facilities across the markets they serve. This role is expected to create documentation of training, development, coaching, and management materials so that the fundamental knowledge base of the Network COE can grow and knowledge can be shared within the organization. Network Directors who are not in new or designate turn-around markets will continue to directly report to their respective Market Presidents.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

Lead and performance manage the designated turn-around Market Network Directors

  • Establishes guidelines and expectations for Network model standards all markets must meet.
  • Mentors, manages, onboards, and develops Market Network Director.
  • Aggressively supports Market Network Directors in obtaining top level performance to meet and or exceed financial plan targets for clinical claim cost.
  • Provides feedback regarding the performance of Market Network Directors to Network COE, CMO, and the local Market President.
  • Speaks to MNDs regularly to receive updates on issues and help coordinate additional support as needed.
  • Travels aggressively to the market in the early phases to help determine opportunities of improvement so the MND can rapidly create a performance improvement plan (PIP).
  • Problem solves with MNDs on opportunities to improve their network quality, collaboration and value.
  • Holds each MND accountable for their progress against annual targets and plans, giving direction when necessary.
  • Works with MNDs and the Referral COE to intervene in underperforming markets.
  • Provides input to the MNDs annual performance appraisals, supporting their Market President, and the Network COE.  Identifies MNDs that need to be replaced after being properly performance managed.
  • Participates in the interview and selection of all new Market Network Directors.
  • Leads in the search for a replacement in conjunction with supportive HR functions after conferring with the market president on the level of talent needed for the position.
  • Determines once the MND has successfully accomplished their PIP and the market is out of turn-around status at which point the MND will report directly to the Market President.

Trains and develops all new Network Directors

  • Leads network startup and development in new markets.
  • Prior to transitioning MNDs to their Market President, completes a standardized orientation to new Network Market Network Directors on their roles and responsibilities to include but not limited to:

o    RITS, Qlikview training.

o    Train on the use of the BI Tools i.e. HITS, RITS, etc.,

o    Formal introduction and orientation at our corporate office to key stakeholders i.e. CSE, BI, Legal, Corporate Compliance, Credentialing, and onboarding,
o    Facilitate orientation and training of the referrals process in collaboration with the Referrals COE.
o    PPL specialist selection, and management.
o    Orientation will take place in the MNDs home market, established high performing market, and at corporate.

  • Assists in establishing relationships with their market health plans for collaboration purposes i.e. JOC meeting with Humana, etc.
  • Orients on recruitment, negotiating, and onboarding of key Tier 1 specialist i.e. cardiology, podiatry, etc.
  • Orients MND on quickly establishing a collaborative relationship with the 4M team specially with the Market Chief Medical Officer.
  • Establishes onsite high-quality cost-effective services i.e. mobile mammogram, nuclear stress testing, etc.

Develops new strategies, contracting approaches and best practices as the central expert in Network

  • Organizes and chairs weekly all-MND conference calls in collaboration with CSE to share and develop best practices.
  • Convenes quarterly or similar MND meetings for training, discussion and performance management.
  • Develops new tools, strategies and approaches to improve patient access to our centers, such as urgent transport, telephone consults, video consults and remote monitoring.
  • Supports Market Network Directors in implementing and refining new contracting arrangements.
  • Codifies and promotes best practices identified across different markets.
  • Provides additional support on a project basis to Network Directors to design and implement service innovations. Works with Network Directors to codify these innovations and implement effective changes to other markets as appropriate.
  • Develops new tools and strategies for Network management, such as improved insight into claims data and tools to strengthen and manage relationships with network partners.
  • Leads research and development into ways to improve comparisons and understanding of cost drivers within and between markets.

Supports relationship building with payers to enhance network collaboration and value.

  • Builds relationships with payer staff that support and collaborate with Network (e.g., Humana referrals approval team).
  • Supports Network Directors in their interaction with payers.
  • Works with payers to improve richness and availability of data available to support Network performance.

Acts as point of interface between Executive team, COEs and Network

  • Collaborates with CSE and BI to improve data insight available to Network Directors.
  • Collaborates with Referrals COE to improve support, processes and execution of referrals.
  • Uses expertise and role to advocate on behalf of Network in company-wide collaborations, strategy development or problem solving.
  • Facilitates interactions with supporting COEs and Network as required to drive forward network performance (e.g., BI, CSE, IT.)

Supports and champions:

  • Relationships with hospital for notifications, hospital medics records, ER units, and alternative to ER care like urgent care.
  • Standards for specialist medical records returns.
  • Relationship with EMS, or fire rescue options.
  • Standardize approach to specialist contractor relationships and evaluation of onsite vs offsite specialists.

Other duties as assigned and modified at manager’s discretion.

Additional Job Description

KNOWLEDGE, SKILLS AND ABILITIES:

  • Results-oriented individual with high personal accountability, high energy, and strong drive to develop him/herself while improving our business model
  • Knowledge and experience in using data to drive results-orientated performance and culture
  • Experience building successful and collaborative relationships with specialist providers, facilities and hospitals
  • Experience managing large team and operational processes (e.g., referrals) and can offer strategies, support and direction to improve their efficiency and effectiveness
  • Demonstrated ability to communicate effectively and openly with members at the executive level
  • Ability to operationalize great ideas through others and understand our internal business culture and adapt to the situation either as a slow consensus builder or a powerful motivator, as needed
  • Maturity and personal leadership in working with and developing Market Network Directors
  • This position requires nationwide travel

EDUCATION AND EXPERIENCE CRITERIA:

  • B.S is required, MBA is preferred
  • Minimum five (5) years’ prior healthcare experience in medical administration, with experience working with underinsured/uninsured patients
  • Passion for helping to improve care for elderly patient populations
  • Understanding of fundamental economics of healthcare and network costs; understanding of value based care.
  • Leadership experience; demonstrated success in growth and/or business development is required
  • Experience interacting with hospitals
  • Experience working with payors, preference toward candidates who have experience contracting with multiple payors and providers
  • Experience designing and negotiating contracts and performance agreements
  • Experience analyzing and using data as core part of role, including use of sophisticated business intelligence tools
  • P&L experience desirable but not essential
  • Excellent written and verbal communications skills with the ability to present to senior executives/Board of Directors
  • Spoken and written fluency in English

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