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Provider Network Director jobs in Massachusetts

Provider Network Director directs and develops a healthcare provider network. Designs and administers policies and services that comply with all contractual and regulatory requirements. Being a Provider Network Director requires a bachelor's degree. Typically reports to top management. The Provider Network Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Provider Network Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

Recently Added Provider Network Director jobs

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Director, Network & Provider Analytics
  • Point32Health
  • Canton, MA FULL_TIME
  • Who We Are

    Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

    We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

    Job Summary

    Reporting to the Vice President of Network and Provider Performance Management, the Director of Network and Provider Analytics plays a strategic leadership role with the Provider Partnerships organization. The Director manages a team of managers and analysts, working in a matrix environment to support and collaborate with colleagues from System Contracting, Ancillary Contracting, Actuarial, Sales and Provider Performance. He/she oversees the development and timely delivery of relevant and meaningful financial analyses in support of Point32Health’s provider contracts and network performance for all commercial and government payor lines of business.

    The Director is will closely collaborate with Commercial and Enterprise functions in delivering the business goals with a strong and collaborative relationship with Finance, Corporate Data & Analytics (CD&A), and Health Care Services, and IT to leverage enterprise solutions built to support business performance. The position will have extensive interaction with the Chief Financial Officer, Chief Actuary, Head of Health Care Services, Chief Information Officer, and other executive leaders across the Enterprise. The Director will also represent the Commercial division’s vision and thought leadership in the areas of network performance and optimization, business intelligence, analytics and insights, and key systems selection and/or enhancements.

    Key Responsibilities/Duties – What You Will Be Doing

    • Proactively identify and oversee the development of analyses, models, and tools to offer an informed view of provider, network, and contract performance
    • In collaboration with System and Ancillary Contracting leadership, formulate and execute on strategies to improve unit cost, standardize reimbursement methodologies, and maintain competitive provider networks
    • Provide direction and define approach and parameters for overall reimbursement strategy and payment methodologies, with the goal of standardization, optimization, and transparency. Oversee development of provider rates in line with negotiated terms
    • Oversee the submission of regulatory submissions and requests
    • Monitor, analyze and report on competitive position for all applicable Point32Health markets
    • Produce accurate and timely reporting on network access and adequacy, ensuring standards are maintained and gaps are appropriately addressed
    • Engage with Sales team to provide compelling information and reporting in support of employer account engagement, actively participating as a subject matter expert in cross-departmental as well as external provider and broker meetings.
    • Actively represent the Provider Partnerships organization in Corporate Data & Analytics, Finance, Actuarial, Trend, Health Care Services, Information Technology, and other department and enterprise governance forums. Provide thought leadership, express business needs, and manage relationships with key internal constituencies
    • Accountable for ensuring the team adheres to enterprise data and analytics governance standards, policies, and procedures
    • Recruit, retain and develop talent. Coach and support staff in analytics, leadership and relationship management to enable a high-performing team
    • Other duties and projects as assigned

    Qualifications – What You Need To Perform The Job

    EDUCATION, CERTIFICATION AND LICENSURE:

    • Bachelor's degree in business, health administration, finance or a related field
    • Master's degree preferred, or relevant experience

    EXPERIENCE (minimum Years Required)

    • At least 10 years of progressive analytic, financial, project and/or operational experience in healthcare with 3 or more years of effective supervisory experience

    Skill Requirements

    • Energetic, goal-oriented leader with a proven ability to deliver results and lead teams to achieve goals
    • Strong working In-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers; solid knowledge of health care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment
    • Prior experience with Business Intelligence tools such as MicroStrategy, Tableau or SAS
    • Excellent quantitative skills with ability to synthesize financial information, create and evaluate options
    • Ability to manage and direct multiple priorities across teams while meeting aggressive deadlines
    • Must have proven ability to work effectively across all levels of the organization on complex issues
    • Excellent verbal & written communication skills
    • Energetic and proactive individual who strikes the right balance between self-initiative and collaboration with others
    • Demonstrated ability to master new content quickly
    • Strong analytic and technical skills with the ability to translate complicated data into useable information
    • Excellent verbal and written communication skills
    • Must have the ability to lead/mentor a team of staff effectively, meet changing business priorities, think strategically, understand and have insight into health care industry with an emphasis on managed care and finance related issues.

    WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

    • Must be able to work under normal office conditions and work from home as required.
    • Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
    • May be required to work additional hours beyond standard work schedule.

    The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

    Compensation & Total Rewards Overview

    As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

    Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

    • Medical, dental and vision coverage
    • Retirement plans
    • Paid time off
    • Employer-paid life and disability insurance with additional buy-up coverage options
    • Tuition program
    • Well-being benefits
    • Full suite of benefits to support career development, individual & family health, and financial health

    For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

    Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

    Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
  • 2 Days Ago
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Provider Network Manager Sr
  • Elevance Health
  • Woburn, MA FULL_TIME
  • Location: NH-Manchester, MA-Boston, MA-Woburn, MA-Newton, CT-Rocky HillJob Description SummaryDevelops the provider network through contract negotiations, relationship development, and servicing. Prim...
  • 8 Days Ago
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Behavioral Health Advanced Practice Provider (NP/PA)
  • Transformations Care Network
  • Marlborough, MA FULL_TIME
  • Join us at Northeast Health Services, a member of Transformations Care Network (TCN), as we embark on an exciting journey to empower Advanced Practice Providers like you in making a difference. We are...
  • 2 Days Ago
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Behavioral Health Advanced Practice Provider (NP/PA)
  • Transformations Care Network
  • Danvers, MA FULL_TIME
  • Join us at Northeast Health Services, a member of Transformations Care Network (TCN), as we embark on an exciting journey to empower Behavioral Health Advanced Practice Providers (NP/PA) like you to m...
  • 6 Days Ago
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Behavioral Health Advanced Practice Provider (NP/PA)
  • Transformations Care Network
  • Dedham, MA FULL_TIME
  • Join us at Northeast Health Services, a member of Transformations Care Network (TCN), as we embark on an exciting journey to empower Behavioral Health Advanced Practice Providers (NP/PA) like you to m...
  • 6 Days Ago
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Behavioral Health Advanced Practice Provider (NP/PA)
  • Transformations Care Network
  • Woburn, MA FULL_TIME
  • Join us at Northeast Health Services, a member of Transformations Care Network (TCN), as we embark on an exciting journey to empower Behavioral Health Advanced Practice Providers (NP/PA) like you to m...
  • 7 Days Ago
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Provider Network Director jobs at Popular Companies

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Audit Director, Payments Network (Hybrid)
  • Capital One
  • New Haven, CT
  • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
  • 6/10/2024 12:00:00 AM
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Audit Director, Payments Network (Hybrid)
  • Capital One
  • Atlantic City, NJ
  • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
  • 6/10/2024 12:00:00 AM
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Audit Director, Payments Network (Hybrid)
  • Capital One
  • Washington, DC
  • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
  • 6/10/2024 12:00:00 AM
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Audit Director, Payments Network (Hybrid)
  • Capital One
  • Dover, DE
  • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
  • 6/10/2024 12:00:00 AM
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Audit Director, Payments Network (Hybrid)
  • Capital One
  • Charlottesville, VA
  • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
  • 6/10/2024 12:00:00 AM
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Audit Director, Payments Network (Hybrid)
  • Capital One
  • Fredericksburg, VA
  • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
  • 6/10/2024 12:00:00 AM
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Audit Director, Payments Network (Hybrid)
  • Capital One
  • Richmond, VA
  • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
  • 6/10/2024 12:00:00 AM
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Director of Networking
  • Insight Global
  • Director of Network Services and Engineering Must be in Nashville, TN - Hybrid schedule of 3 days onsite Requirements: 1...
  • 6/7/2024 12:00:00 AM
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About Massachusetts

Massachusetts is the 7th-smallest state in the United States. It is located in the New England region of the northeastern United States and has an area of 10,555 square miles (27,340 km2), 25.7% of which is water. Several large bays distinctly shape its coast. Boston is the largest city, at the inmost point of Massachusetts Bay, and the mouth of the Charles River. Despite its small size, Massachusetts features numerous topographically distinctive regions. The large coastal plain of the Atlantic Ocean in the eastern section of the state contains Greater Boston, along with most of the state's po...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Director jobs
$189,610 to $244,968

Most Popular Cities in Massachusetts for Provider Network Director Jobs

What does a Provider Network Director do?

Provider Network Director in Columbus, OH
In either scenario, taking these three steps can help you determine whether a network change will genuinely lower your costs.
February 09, 2020
Provider Network Director in Portland, ME
We offer providers a value-based reimbursement model centered on aligning quality measures, HEDIS measures and HH incentives to reward high-quality care of the members you serve.
December 12, 2019
Provider Network Director in Temple, TX
However, from a state regulator’s and the health plan’s perspective, the sheer number of providers in the network overall is only part of the story.
December 21, 2019