Director- Medical Network Management

Location: Lee’s Summit, MO
Location: Missouri-Remote

GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.

As a condition of employment, all GEHA employees must be fully vaccinated against COVID-19 unless a medical or religious exemption is approved.

GEHA is looking for a Director to lead the (Medical) Network Management team, Network Program team, and Strategic Partner Management functions. This person will be responsible for the oversight of national carrier networks, including monitoring network compliance, operational strategy. You will oversee the Accreditation processes, in partnership with legal and compliance, as it relates to related to our carrier network and ancillary network partnerships, and direct contract(s). You will have responsibility for the Strategic Partner Management support-acting as an internal consultant to provide strategic contracting and partnership support to other business units. Develops and maintains important business relationships with internal and external partners. Manages the cost containment vendor solutions, helping to develop strategy, implement expansion of programs and oversee results of the programs. You will work with all partners to leverage existing capabilities and measure potential business opportunities. You will have responsibility to manage department budgets, goals, and will serve as a consultant and liaison for major projects and initiatives.
SKILLS

Primary responsibilities:

• Oversight of contracted provider networks and ancillary network partnerships (e.g. telemedicine): oversees contract compliance/performance guarantees, and analyzes network performance to maintain expected savings.

• Develops and maintains effective business relationships with all strategic partners.

• Works as a key stakeholder to support the GEHA Vendor Management Office during the provider network RFI & RFP processes including assisting in the development of RFP questions, analysis and scoring of responses, and network selection.

• Manages, in conjunction with GEHA’s legal and compliance teams, the ongoing accreditation policies and procedures to ensure compliance.

• Works in conjunction with internal audit, SIU, appeals, and claims to handle escalated provider and member issues.

• Provides oversight for GEHA’s cost management vendor relationships, evaluating current programs, identifying new opportunities for additional savings, continually monitoring program results.

• Manages coordination of departmental efforts with external departments to ensure compliance with product guidelines.

• Provides strategic contracting and partnership expertise to internal business units.

• Translates complex, technical information in presentation-friendly formats including graphical displays to a wide variety of executive audiences.

• Translates strategy into defined tactics, programs/projects, priorities, and timelines and ensures alignment and attainment of both the regions and the enterprises strategic plans to turn strategy into reality.

• Manages vendor interaction and management, including vendor selection, contract and rate negotiation, issue resolution, developing and reviewing statements of work, representation on vendor business and Executive committees, speaking engagements, etc.

• Manages planning and administration of expense and capital budgets for subordinate department(s).

• And other duties, as assigned.

Qualifications:

• Bachelor’s degree in a health-related field or commensurate experience

• Additional years of experience will be considered in lieu of education

• Eight (8) years of related experience to managed care, strategy, and/or consulting

• Four (5) years of leading direct and indirect reporting teams

• Combination of education/experience which provides equivalent background will be considered

• Working knowledge of managed care programs and provider networks

• Strong communication and collaboration skills, ability to communicate effectively with senior management

• Proficiency with MS Word, Excel, and PowerPoint

• Demonstrated leadership skills, ability to coach, mentor, and foster a culture of continuous learning, empower and motivate others

• Strong independent decision making, influencing, and analytical skills

• Experience and demonstrated success in managing and motivating a large, diverse staff and the ability to effectively resolve problems with other departments and at all management levels

#LI-Hybrid

GEHA is an Equal Opportunity Employer. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. Our company’s corporate headquarters is located in Lee’s Summit near Douglas Rd and I-470 with a total of five locations in the Kansas City metropolitan area.