Our client, one of the nation's largest not-for-profit Medicare Advantage plans, has been dedicated to keeping Seniors both healthy and independent for many years. Their employees are passionate about helping Seniors, and understand that success is based on achieving the mission.

The Job

Responsible for the overall financial and regulatory performance of our client’s provider network. Develops and implements the strategic direction for the network and oversees network management operations to build and maintain a high performing provider network.

Defines long-term strategic goals for our client’s provider network and develops clear plans to achieve them.

Oversees operations that develop and maintain positive relationships and financially viable contracts with medical providers. Engages contracted network leaders and establishes and maintains positive business relationships. Negotiates contracts with high priority providers.

Collaborates with the Sales organization to execute company growth initiatives through the acquisition of new networks, providers, and vendors.

Accountable for provider performance related to financial, operations, regulatory, quality, and member satisfaction targets and other performance-related priorities. Ensures providers understand and commit to performance goals.

Leads key initiatives and collaborations that involve network partners.

Works across the organization, with clinical and administrative areas, to develop and deploy provider systems, standards, policies and procedures to improve network performance.

Oversees Network administrative functions, including budget management, internal and external audit, regulatory compliance, contract administration, and policy and procedure enforcement.

Collaborates with senior leaders to establish and achieve financial and membership growth targets. Contributes as a corporate leader by providing recommendations, direction and support of short and long-term company strategies.

Directs and supports staff to achieve organizational goals by communicating job expectations, planning, monitoring and appraising job results, coaching and counseling, driving increased employee engagement, and developing and maintaining succession plans.

Your Qualifications

• Bachelor’s Degree in Business Administration, Public Health, Public Administration or related field of study required
• Master’s degree in Health Care or Business preferred.
• 10+ years of experience in Managed Care with provider management and contracting is required.
• 5+ years of experience in an executive level position required.
• Expert knowledge of Medicare Advantage Products.
• Knowledge of industry standards, current trends and their application to a Medicare Advantage plan.
• Sound business and financial judgment with problem-solving abilities.
• High commitment to customer service.
• Executive presence and the ability to communicate at the Board Level.
• Exceptional interpersonal skills and excellent oral and written communication.
• Proven ability to interact effectively with all levels of the organization.

What's in it for you?

• A competitive compensation and benefits program
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Ten paid holidays per year
• Excellent 403(b) Retirement Saving Plan with employer match
• Business Casual attire
• Robust employee recognition program
• Tuition reimbursement
• A work-life balance and much more!