Provider, Network Manager at Teclab Management Services Limited

Job Description

• You are expected to work directly and give direct support services to your business unit as it relates to all assignments you may be given.

Responsibilities

• Design and implement programs that help us build and nurture positive relationships between the health plan, providers and practice managers
• Implement strategies for the development of provider networks, identify gaps in network composition and services, and assist the network staff to prioritize contracting needs.
• Develop the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.)
• Yield a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners.
• Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
• Establish and maintain strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.
• Manages the development of a healthcare network.
• Oversees the negotiation of managed care or other payer contracts
• Responsible for daily activities, provider relations, and credentialing
• Anticipate customer needs and proactively develop solutions to meet them.

Requirements

• Entrepreneurial and Numerical Competence
• Business Consulting and Development
• Competency Management
• Complaint & Conflict Management (Emergency/ Crisis Management)
• Customer Focus
• Information Management
• Learning and Self Development
• Negotiation

Qualifications

• First Degree in Humanities, Master’s degree in business, health care management or related field
• Minimum of 7 Years' Experience, with 5 Years' Experience in a Network Management Role.

Competencies Required:

• Strong negotiation skills and experience
• Excellent problem solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Excellent verbal and written communication and relationship skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

Technical:

• Ability to develop and manage network strategies in a start-up environment
• Knowledge and experience in deployment of various reimbursement and risk-based methodologies
• Ability to utilize financial modeling and analysis in decision making
• In-depth knowledge of the network strategy and contracting process

Attitude:

• Must be Friendly, honest, transparent and diligent in all dealings.