Senior Director, Network Contracting

Company: Sentara
Location: Portland
Posted on: March 14, 2023

Job Description:

City/StateNorfolk, VAOverviewWork ShiftFirst (Days) (United States of America)Peer Relationships:

• Work effectively with Provider Education and Service in order to support contract negotiations and provider issue resolution.
• Work effectively with Network Strategy to implement strategic objectives, improve processes and ensure high quality contracts.Matrix Relationships:
  • Serve internal customers, including sales and government programs, ensuring all client's network needs are met and then exceeded.
  • Work Collaboratively with Clinical, Sales, Actuary/Finance, Claims, System Configuration, IT, Provider Operations, Medical Economics, Clinical Data, VBC/Enablement, Compliance, Government Programs, Legal and others to ensure negotiated contracts do not result in operational disruption, are compliant with all laws and regulations and result in the effective administration of healthcare, including contractual obligations for providers to work electronically such as clinical data exchange.Job SummaryNetwork Management is comprised of three primary functions: Network Contracting, Provider Education and Service and Network Strategy. The Senior Director, Network Contracting will lead Contracting across VA and contiguous states for the Commercial, Medicare and Medicaid product lines for Facility, Ancillary and Professional Providers. The position will have oversight for Behavioral Health, Medical Surgical, SCAs and Vendor contracts, including Network Adequacy and Network Analytics for Sales. This role will also oversee Value Based Contracting for Facility, Ancillary and Professional Providers for the Commercial, Medicare and Medicaid product lines, utilizing Value Based Contracts to obtain market competitive rates and the achievement of both high quality, low cost medical/behavioral services. The Senior Director, Network Contracting will implement the Network Strategy and work collaboratively with Provider Education and Service to ensure high provider satisfaction and with VBC/Enablement to develop new VBC templates as needed. The Senior Director, Network Contracting will have oversight for all Network Development and rate/language/methodology remediation.
    
    
    Requires a Bachelor's degree and minimum of 15 years experience in provider contract negotiation and 10 years experience managing provider contract negotiation. Expert in commercial facility contract negotiation experience. - Expert/Intermediate level understanding of payment methodologies for Commercial, Medicare and Medicaid for Facility, Ancillary and Professional providers. Expert in provider contract negotiation for Commercial, Medicare and Medicaid for Facility, Ancillary and Professional providers.Qualifications:BLD - Bachelor's Level Degree (Required)Negotiating Mng Care ContractsSkillsSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.In support of our mission "to improve health every day," this is a tobacco-free environment.

Keywords: Sentara, Portland , Senior Director, Network Contracting, Executive , Portland, Maine