Provider Network Developer
Under the direction of the Provider Network Manager, the Provider Network Developer manages and coordinates current and new contracted services for providers used by members. They provide customer service, guidance, and communicate regularly with key personnel to successfully implement service activities, and facilitate the execution of planned network objectives while balancing the goals and costs of the service providers. All of this is done to support the organization’s dedication to providing accessible, cost-effective, high-quality, person-centered care that puts the member first.
Goals, Objectives, and Responsibilities
Goal & Objective: Collaborates with members, local organizations, providers, and staff to implement service contracts.
Related Responsibilities
* Identifies, evaluates, and selects service providers which best meet the business needs and provide quality services. Works with providers to develop strategies for specific needs.
* Determines network adequacy and recruits new providers to fill in gaps that have been identified.
* Track costs per unit activities to determine cost per service data.
* Coordinates strategic plans to meet financial objectives while balancing goals and costs of the provider network.
* Provides system support, training, and guidance on the functionality of the provider network.
Goal & Objective: Collaborates with providers to ensure the organization exceeds members’ expectations.
Related Responsibilities
Creates and maintains strong working relationships and monitors on-going activities related to claims resolution, provider information and contract support relative to contract activities, regional audit of quality issues related to provider care and service delivery.
* Ensures that providers are contracted at market competitive rates.
* Performs financial analysis of rate proposals.
* Ensures that participating providers are educated about Family Care and are satisfied with the relationship.
* Assists with the credentialing and certification process of the provider network.
* Establishes and maintains a proactive partnership with service providers to ensure that their needs are met. Capitalizes on opportunities, through proactive management and analysis, while balancing the organizational goals and costs.
Goal & Objective: Acts as an advocate for members.
Related Responsibilities
* Assists in the investigation of suspected incidents of neglect and abuse.
* Ensures that the provider network directory accurately reflects network information.
* Prepares and facilitates operational meetings with the providers consistent with the Relationship Management guidelines.
Goal & Objective: Supports team member excellence.
Related Responsibilities
* Performs other duties necessary to fulfill the responsibilities of this role. Fills-in wherever needed in order to achieve the mission and goals of the organization or at the request of the Provider Development Manager.
Necessary Training and Experience
NorthernBridges expects employees to understand and to incorporate the values of our organization in their day-to-day practice. While ensuring that statutory parameters are satisfied, the organization is willing to consider a combination of the following education, training and experience requirements, which provides the necessary abilities to perform the duties of this position.
* The NorthernBridges Provider Network Developer must have bachelor’s degree in healthcare administration, accounting, or equivalent and a minimum of two years experience in non-profit, government, human services, or the long-term care setting.
* There is a strong preference for candidates with a master’s degree in healthcare administration or equivalent.
* Working knowledge of federal rules and regulations of Medicaid benefits for long-term care; and contract policies and procedures.
* Skill in developing and managing service contracts
* Maintain the integrity of highly confidential business and client information
* Champion for change
* Influencing
* Leadership
* Communication, facilitation and presentation skills
* Problem solving and decision making
* Effective conflict resolution skills
* Ability to create employee and member satisfaction with interactions
* Strong organizational habits
* Software proficiency which would include advanced skills in the use of Microsoft Word, PowerPoint, and Excel programs
* Information and technology proficiency
* The Provider Network Developer may be required to travel to other locations, and therefore will be required to hold a valid driver’s license and have access to reliable transportation.