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Director, Delegated Provider Network


This is a Full-time position in Fort Lauderdale, FL posted November 24, 2022.

Embrace better opportunities.
Are you passionate about health, happiness and helping others? So are we. We’re committed to helping our health plan Members live a happy and healthy lifestyle, and we believe that it starts here first, with our Associates.
At AvMed, we provide the tools and opportunities to enhance, expand, and support each Associate’s personal and professional growth. From tuition reimbursement to exercise classes in the office, embrace a better career with AvMed and join our team!
Position: Director of Delegated Provider Networks
Scope of position: The Director of Delegated Provider Networks has overall responsibility and accountability for the contracting and servicing of all delegated provider networks in Florida, which represents an annual spend of nearly $80M, to achieve financial, service and quality objectives. This achievement requires that AvMed’s provider networks across all markets are competitive with the larger regional and national health plans in discounts, size and composition. This successful Director will work in conjunction with the Vice President of Provider Contracting & Service to develop and execute on the strategy for the delegated provider networks related to the selection and implementation of vendors and their oversight in order to optimize member outcomes and cost efficiencies.
This individual will also effect change and achieve prescribed goals through example, engagement, ensuring that all delegated provider network negotiations are planned well in advance and completed on time and within the unit cost targets; and resolve internal and external issues (whether minor or complex) in a timely, effective and responsive manner. Initially, He/She will also initially manage a contract negotiator who will assist the Director in contract negotiations, vendor implementations, and other duties as assigned. Over time, this responsibility may evolve to managing a team of contract negotiators. The delegated provider networks for which the Director is responsible will have high provider and member satisfaction, be cost effective, and demonstrate a high level of compliance with AvMed’s quality initiatives.
Essential Job Functions:
Responsible for contracting, servicing, and retaining a quality cost effective network of delegated provider networks that provide specialty services to AvMed members. The networks will be measured by their performance, service level guarantees, and medical cost targets.
Employs focused and organized relationship management approaches to build strong relationships with the provider networks; and ensures that a high level of service and interaction is provided including accurate and timely issue resolution, performance recognition, education programs, and organizational support.
Oversees new provider network implementations which includes interfacing with multiple areas in the organization such as IT, Claims, Medical, Pharmacy and Data Management to ensure provider network contracts are administered.
Analyze provider spend, medical trend reports and competitor coordination of benefits data to identify network cost reduction opportunities.
Develops and distributes requests for proposals for desired provider networks.
Manage the Delegated Provider Network annual operating and capital budgets within industry standards and best practices in order to maintain an affordable and efficient cost structure.
Work with General Counsel on contract language and updates in accordance with current legislature and CMS requirements.
Directs the work activities of staff in the department; works with Human Resources to recruit, interview, select, and hire associates; coaches, mentors and develops staff including developing employee onboarding and career development plans; outlines specific performance metrics for the department and provides ongoing constructive feedback.
Performs additional duties and responsibilities as assigned by management.
We Offer:
Competitive Salaries
Comprehensive Benefits: Medical Plans, Health Savings Account, Dental, Vision, and more…
Paid Time Off, Company Paid Holidays, Paid Time Off Cash-In
401(k)plan with matching contributions, Tuition Assistance, Associate Discounts
You have:
Bachelors required
Masters preferred
10+ years of experience of provider and/or payer contracting
5+ years of experience in a network management-related role handling complex network providers and negotiations these providers with accountability for business results
5+ years’ experience working with a managed care organization or health insurer, or as a consultant, in a network/contract management role such as contracting, provider services, etc.
In-depth knowledge of physician and ancillary payment methodologies including but not limited Capitation and RBRVS.
You May Also Have:
Excellent verbal and written communication skills
Possess strong skills in prioritizing and aligning resources to achieve key objectives
Demonstrate an ability to handle multiple and competing priorities simultaneously
Self-motivated and able to lead and excel in a high pressure environment
Possess an organizational focus and understand the perspective of different functional areas
Fully understand the business, legislative, regulatory and competitive environments
Make timely decisions, readily understand complex issues, and develop solutions that effectively address problems.
At AvMed, you’ll find a family. Our Associates love all the opportunities for advancement, the flexible work environment and team activities. We also encourage our Associates to embrace a life rich in what matters most – health and happiness. We call it being WELLfluent. Join AvMed. Join the WELLfluent!
Location: Ft. Lauderdale, Florida
This position is Hybrid 3 days in office and 2 days remote
AvMed is a tobacco/drug free workplace, EOE
Associated topics: 3pl, buyer, inventory, logistics, procure, purchase, purchasing manager, supply chain, turnaround, warehouse