Job Description

MARKET NETWORK MANAGER

ArchWell Health is re-imagining the practice of primary care. We are putting the relationship between member and physician at the center of a value-based model focused on outstanding member experience, improved access, and better outcomes. In our medical clinics, we provide comprehensive primary care for senior adults with traditional Medicare and Medicare Advantage plans, focused on delivering improved quality, better member experience and lower total cost of care.

JOB SUMMARY:

Our care team is extended by the clinical support team, creating a seamless experience for our members to ensure they are cared for and coordinate the care needed outside of the clinic. The Market Network Manager is a critical role to create the infrastructure and processes needed to manage this referral network.

Partnering with the broader market leadership team, the Market Network Manager is responsible for building a comprehensive network strategy to support market growth. This is accomplished by building a high-performance network of preferred external specialists and facilities. The Market Network Manager will manage a team across all centers in their region, ensuring the day-to-day referrals and diagnostic orders for ArchWell Health members to see specialists outside the clinic are handled with care and in a timely manner. S/he should be well-versed in data-driven approaches and systems, bringing analytical rigor to all aspects of the role.

DUTIES/RESPONSIBILITIES:

• Oversight of network operations, ensuring a high-performance network is established and referrals are systematically & seamlessly coordinated for ArchWell Health members
• Build the provider and specialty network in market through the lens of key performance indicators and medical economics and trend data; use this analysis to create a long-term network strategy
• Identify ways that health plan provider networks can be diversified to accommodate current and future client needs, improve quality, and reduce costs of service
• Negotiate contracts with specialists, hospitalists, and other provider groups to ensure greatest continuity of care for members; work cross-functionally with various departments to ensure contracts meet operating, financial, and legal standards
• Oversees compliance with government programs such as Medicaid and Medicare for all contracting and network development purposes
• Manage, coach, and mentor the referral team of care coordinators; in addition, provide training and input for market staff on network and referrals strategies to ensure highest level of member satisfaction
• Development and oversight of referrals processes, including review, authorization, follow-up, and coordination with providers, generating regular referral workflow and analysis reports
• Manages provider network costs, by ensuring appropriate coverage and minimizing extra payment costs
• Employ a data-driven approach to monitor and evaluate the network for continuous improvement

REQUIRED SKILLS/ABILITIES:

• Experience with a payer or provider building provider networks is preferred
• Knowledge of Medicaid/Medicare plans, federal, and state legislation
• Excellent critical reasoning, decision-making, and problem-solving skills
• Experience building, managing, and coaching a team, with a focus on customer service
• Experience with claims/quality reports and analytical software packages
• Must possess a high degree of emotional intelligence and integrity; driven and focused work ethic
• Strong communicator that is customer-oriented
• Self-starter with the ability to think creatively and work effectively
• Ability to travel on occasion for company meetings, contract negotiations, and vendor management
• Team oriented and entrepreneurial

EDUCATION AND EXPERIENCE:

• Bachelor’s degree in Business Administration or a closely related discipline required; Master’s degree preferred
• A minimum of 5 years building provider networks
• A minimum of 3 years of management experience
• Experience in provider contract negotiations, including FFS, capitation models, and pay for performance models is preferred
• Excellent analytical, strategic thinking, and creative thinking skills
• A passion for mentorship and team-development
• Embodies and serves as a role model of ArchWell Health’s Values:
  • Be compassionate
  • Strive for excellence
  • Earn trust
  • Show respect
  • Remain resilient
  • Do the right thing and do it with passion

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