Director, Network Management - Remote

Sentara Healthcare is currently recruiting for aDIR, Network Management (VA West Region)to work with our Optima Health Plan.Responsible for developing and maintaining statewide provider networks to include provider contracting and negotiation, education, program implementation and ongoing issue resolution. Responsibilities also include the development of goals, objectives, and policies that support the strategic objectives of the division. Responsible for day-to-day leadership and development of assigned members of the team.Travel required throughout VA to meet with Providers. Ideal candidate will live in VA or NC. Will consider a telecommute opportunity, if not near an office and you live in one of the following states:Virginia, North Carolina, Florida, Nevada, Wyoming, South Dakota, Washington State, Indiana, Georgia, South Carolina, Tennessee, Texas, West Virginia and Wisconsin. Will be responsible for the following Network Management responsibilities:Manage a team contract negotiator ensuring their success across Virginia North/West RegionsFacility, Ancillary and Physician contracting for Medicare, Medicaid, and Commercial ProductsNegotiate Value Based Contracts (VBCs)Performance Based ContractsShared SavingsShared RiskFull RiskLead Network Development initiatives ensuring network adequacy and provider adds required to attract membershipAchieve Budget Remediation such as Medical Expense Committee projects and Market Competitive PricingEnsures the administration of VBCs by Optima and addresses Provider requests for enhancementConduct Negotiator training and educationAll Payment MethodologiesVBCProvider Negotiation SupportApprover for Non-Standard/Non-Preferred Payment MethodologiesApprover for Non-Standard languageEnsures the administration of Non-Standard/Non-Preferred Payment Methodologies and languageManage staff responsible for provider data pulls to support announcements, NCQA, contracting efforts, medical expense committee projects and other ad hoc provider data pullsFT/Day Shift PositionRequired Education: Bachelor's Level DegreeRequired Experience: Managed Care - 5 years, Management - 5 years, Network Management - 5 years as well as experience in commercial facility contract negotiations, such as fixed pricing payment methodologies, chargemaster cap management and the ability to achieve market competitive rates (including decreases). Will consider Health Plan or Health System negotiation experience. Responsible for developing and maintaining statewide provider networks to include provider contracting and negotiation, education, program implementation and ongoing issue resolution. Responsibilities also include the development of goals, objectives, and policies that support the strategic objectives of the division. Responsible for day-to-day leadership and development of assigned members of the team.Education LevelBachelor's Level DegreeExperienceRequired: Managed Care - 5 years, Management - 5 years, Network Management - 5 yearsPreferred: None, unless noted in the "Other" section belowLicenseNone, unless noted in the "Other" section belowSkillsRequired: Microsoft OfficePreferred: None, unless noted in the "Other" section below