Director, Network Management

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

The National Director, Network Management leads the execution of Privia's comprehensive network roadmap, which is focused on reducing the total cost of care. This role leverages clinical and financial data to guide local primary care physicians and market teams in selecting preferred specialists, surgical centers, skilled nursing facilities (SNFs), and other high-value acute/post-acute network partners. The Director partners closely with Privia's market operational and population health teams to develop, document, and drive forward the plan, ensuring the successful execution of defined milestones. This position establishes shared goals with stakeholders, acts as the network subject matter expert, and ensures all network activities support primary care fee-for-service revenue.

Primary Responsibilities: 

• Work with market leaders to develop, document, and execute Privia’s network management roadmap to measurably and favorably impact total cost of care.

• Collaborate with Market, Provider, and Payer Leadership to identify key opportunities for priority contracts, create goals, and facilitate sharing across markets and between entities.

• Review and interpret market intelligence derived from clinical and financial data for preferred networks among both PMG and PQN providers to inform network decisions.

• Partner with IT teams to implement operational workflows that enhance the efficiency and effectiveness of network management across all markets.

• Develop and expand tactics like eConsult models, decision support, patient outreach tools, and similar to facilitate necessary referrals and ensure care is most likely to occur with high quality, low cost, and accessible providers.

• Manage external vendors and delegated partners that are leveraged to effectuate network management tactics, ensuring performance accountability, successful integration, and alignment with Privia’s strategic goals.

• Act as the internal subject matter expert for Market Teams and Providers, on network topics, such as keepage, appropriate referral volume, preferred provider relationships, and payers’ High-Value Networks.

• Partner with market teams to develop strategic care delivery relationships with healthcare entities, including specialists, and later, hospitals, skilled nursing, and other sites of care.

• Ensure diligent execution of the network management roadmap, tracking progress against key milestones and proactively addressing any potential roadblocks.

• Masters Degree, MPH, MHA, or MBA preferred

• Analytical, quantitative and financial skills

• Experience in business development

• Knowledge of interoperability of electronic health records in coordination with network partners

• Background with providers in clinically integrated networks

• Ability to work in a fast-paced and changing work environment

• Understands the continuity of patient care across multiple entities

• Can develop Partner Compacts and Clinical Protocols

• Creates accountability with partners to perform

• Understands the role of specialists and outside facilities in population health management

• Knowledge of medical claims terminology

• Experience with utilization and medical cost reporting

• Knows how to leverage data to identify high quality / low cost partners

• Accountable with network partners on regular reporting metrics & goals

• Can format data into understandable reports for communication to doctors and administrators

• Must comply with HIPAA rules and regulations

The salary range for this role is $125,000.00 to $140,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% and restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.