Senior Director of Network Operations

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit Amida Care for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Senior Director of Network Operations. Compensation will be commensurate with experience.

Position Summary:

The Senior Director of Network Operations is responsible for the overall planning, implementation, evaluation and day-to-day management of the Provider Services Department, and is responsible for ensuring the development and maintenance of a network of providers sufficient to ensure provision of the Plan benefits.

Responsibilities:

• Serve as the senior leadership point person for provider network services and performance in all activities, meetings, and committees of the organization and with internal and external audiences, including providers, vendors, and State regulators.
• Ensure regular site visits with provider community to proactively engage with providers and seek out opportunities to strengthen relationships.
• Responsible for oversight, management and reporting for all providers participating in the Quality Incentive Program. Develop value-based contracting metrics and contract monitoring procedures.
• Drive the design and development of a robust suite of analytical tools and provider performance metrics that will serve to enhance provider performance strategies, priorities, and activities as a key factor in achieving results.
• Acts as a business sponsor and owner for all Provider departmental reporting and technology system’s needs.
• Develop and retain effective relationships with physicians and business leadership of key physician groups, to drive business results.
• Perform financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives.
• Develop and implement clear and documented processes for provider operations (e.g. provider manual, provider communications, and provider on-boarding).
• Negotiate hospital, physician groups and specialty contracts/service agreements in accordance with Corporate, health plan and government regulations and guidelines.
• Oversee the development, maintenance, and reconciliation of physician risk contracts and capitated arrangements in partnership with internal support teams such as Finance, and Value-Based Operations.
• Responsible for timely and accurate reporting for regulatory and compliance related activities.
• Responsible for the hiring and retention of quality staff and the on-going planning, monitoring, training, coaching, evaluation, and appraisal of staff performance and development to ensure successful achievement of goals and objectives.
• Other duties as assigned.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

EDUCATION REQUIRED

• Bachelor’s degree

EXPERIENCES AND/OR SKILLS REQUIRED

• Seven (7) years’ experience in contract negotiations, network development and provider engagement.
• Seven (7) years’ experience in a Health Plan setting.
• Five (5) to seven (7) years of New York State Medicaid experience.
• Strong analytical and organizational skills.
• Advanced proficiency in Microsoft Office software (Word, Access, and Excel).
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.