Veterans, Reservists, Guardsmen and military family members are encouragedto apply!!

　　We offer remote work opportunities (AK, AR, AZ, *CO, FL, HI,IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC,ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)

　　Job Summary

　　Develops and maintains provider relationships within designatedstate/territory, inclusive of relationships with both TriWest NetworkSubcontractors and any directly contracted provider groups. Manages networkdevelopment activity with network subcontractors/network providers to ensurenetwork meets all access standards. Provider network includes hospital,physician and ancillary service agreements. Provider Network Manager ensuresadherence with government operational manuals, monitors network access,and resolves access issues throughout the assigned region. Facilitatesresolution of escalated provider issues, and promotes TriWest Corporateinitiatives. Ensures that Network Subcontractors fulfill all performanceobligations defined in their Health Network Agreement.

　　Education & Experience

　　Required:

　　Bachelor's degree in Business, Health Care Administration or equivalentexperience2+ years of experience managing large or complex provider networks5 years of experience in a Managed Care or equivalent health care environment2+ years of experience managing provider contracts including pricing,discounts, and all associated terms and conditions

　　Preferred:

　　Experience in provider contracting for government programs and/or commerciallines of businessHas established relationships and resides in the market for the which theposition is locatedManagement experience in the healthcare industryExperience in utilizing a contract management system to manage contractingworkflowNegotiation experienceUnderstanding Claims issues and terms

　　Key Responsibilities

　　Maintains relationships with Network Subcontractors in state/market ofoperations.Develops negotiation strategies for areas of responsibility to achieveindividual and department performance metrics.Develops strategic plan to meet network adequacy needs for areas ofresponsibility and submits to department leadership for inclusion in overallnetwork development plans.Coordinates with Federal stakeholders to deploy network solutions to adhere torequirements of the contracts held by TriWest.Collaborates with Federal stakeholders to identify areas of provider trainingand education to be incorporated into the TriWest provider education plan.Aligns with Network Subcontractors and Federal Stakeholders to identify areasof opportunity for deployment of alternative payment models to supportTriWest's network and improve health care outcomes.Collaborates with internal leadership team to address network access.

　　Supports providers as needed, with issues related to claims, referrals,or any other program related activity.Demonstrates and maintains current knowledge of all programs, contracting,credentialing, reimbursement and operational policies and TriWestinitiatives, operations, and goals.Reviews systems/work flow processes and procedures to identify/recommendopportunities for productivity and process improvement.Collaborates closely with other department leadership, staff, andexecutive leadership on process improvement to promote service levelimprovements or facilitate new processes.Monitors and responds to network shortfalls within region through coordinationwith network subcontractors where appropriate.Regularly reviews and determines appropriate network access and developmentand makes recommendations to support network build activities.Provides regular updates to department leadership regarding provider networkdevelopment, management, and access for assigned areas.

　　.:

　　Communicates information regarding market needs, competition, and industrytrends to management team.Proactively manages provider networks in a signed areas and functions asprimary internal spokesperson on network issues.Regularly meets with network subcontractors/network providers to informpartners about progress towards agreed-upon goals and upcoming networkenhancements; coordinates account planning and maintenance issues.Performs other duties as assigned.Regular and reliable attendance is required.

　　Competencies

　　Communication / People Skills: Ability to influence or persuade othersunder positive or negative circumstances; adapt to different styles;listen critically; collaborate.

　　Computer Literacy: Ability to function in a multi-system Microsoftenvironment using Word, Outlook, TriWest Intranet, the Internet, anddepartment software applications.