SCOPE OF ROLE

The Network Delivery Development team is responsible for partnering with our Care Partners including all other Network relationships to turn their provider networks into market leading and high performing integrated delivery systems. We are reimagining how the network development, network management, and provider relations functions can advance affordable, simple, and personal care for our members. The Regional Manager, Network Development will be a leader on our team and will act as a thought leader for the entire organization with specific Regional responsibilities as assigned. This position will play an integral role in driving the company’s performance by building, optimizing, and transforming our insurance networks. This position will be responsible for supporting Bright’s relationship development with key Regional and local network participants across their designated Regions of Bright’s insurance networks as well as for advancing reimbursement best practices alongside our Care Partners.

ROLE RESPONSIBILITIES

The Regional AVP, Network Development job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Develops, organizes and manages execution of the Region Network Strategy for the development of provider contracting efforts and team member assignments from start-to-finish, including but not limited to process oversight, strategic diligence, outreach, and contract negotiations with regards to mid-sized and large hospitals and health systems, large and small physician groups and ancillary providers to execution.
• Lead Bright Health network development efforts across designated Region consisting of several new and existing markets, partnering closely with market teams, sales, Health Optimization, and other Integrated Delivery Development functions. Develops and assists with Network employee training to ensure consistent Care Partner engagement regardless of the Market.
• Oversees, leads and manages the collaboration with Care Partners to analyze, design, and develop networks through ongoing evaluation of both current and potential network participants. Collaborates with Smart Networks on documentation of curated market network strategies to demonstrate high performing networks within their assigned Region.
• Develops and Supports enhancement of Bright’s portfolio of strategic multi-regional network partnerships to compliment local network development efforts aligned within designated Region. Ensures effective management and oversight of these relationships through ongoing engagement and corrective action plan recommendations, as required.
• Manage ongoing network participant participation and performance, including performance analytics and management as well as contract renewals and terminations. Participates in Market stakeholder meetings and prepares written recommendations on network strategies to obtain market leading high performing networks to improve affordability and improved member quality results. Maintains and updates annual network optimization strategy for each Market in alignment with Market Leaders
• Partner and participate with stakeholders across the organization including but not limited to sales, finance, regulatory, medical management to drive strategic priorities and initiatives.
• Monitor utilization/trends for non-participating providers and execute on organizational strategies to ensure members are seeking care with participating providers when appropriate and initiating closing Network gaps as identified.
• Accountable for leading negotiations with Care Partners and other sophisticated entities as assigned or as identified within assigned Region. Prepares written status updates for key stakeholder reviews and aligns other network opportunities to ensure Market initiatives are met.
• Assess, manage, and develop network development team members to support achievement of network development goals. Prepares annual assessment of network team member to develop succession planning, team member skills development needs including individual feedback on skill improvement needs
• Other duties and responsibilities as assigned.

SUPERVISORY RESPONSIBILITIES

• This position has supervisory responsibilities for assigned Regional Network Strategy/Development employees.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Master’s preferred, minimally a Bachelor’s Degree in business, economics, healthcare administration, or a related field is required; extensive relevant experience will be considered in lieu of a degree.
• Twelve (12) years of experience, with at least seven (7) years of experience in network development, network management, or reimbursement model design required.
• Seven (7) years prior management experience strongly preferred.
• Experience with successfully executing and implementing payer-provider contracts or partnerships required for Commercial, Medicare and Medicaid lines of business including experience with Value Based Incentive Risk and/or Shared Savings network contracting models.
• Proven experience with developing, presenting and analyzing various types of financial analyses, contracting models and network engagement in order to make informed strategic decisions required.

PROFESSIONAL COMPETENCIES

• Desire and ability to move quickly between strategic leadership, tactical execution, and managing analytics
• Knowledge of managed care practices and procedures, specifically in contracting language and negotiations. Provider relations is preferred
• Ability to effectively engage providers, ranging from national providers to regional integrated delivery systems to local physician practices
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures
• Excellent multitasking and prioritization skills with a proven ability to manage multiple projects in parallel to completion
• Superb written and verbal communication skills with an ability to effectively collaborate with internal and external executive leadership

WORK ENVIRONMENT

The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.