Regional Director of Network
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.
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