Director of Network Management

Role Snapshot
Our Director of Network Management serves as a key resource to the Health Plan for shaping the future of our healthcare services. They will lead all aspects of network development, contracting, provider relations and credentialing. This Director is responsible for negotiating favorable contracts and ensuring our providers are engaged and aligned with our mission of delivering exceptional patient care. They oversee the complete network lifecycle from strategic planning to day-to-day operations. Our Director of Network Management oversees the creation, management, and execution of all provider contracts. Will collaborate with cross-functional teams to align network performance with our organizational goals, manage the departmental budget, and maintain compliance with all regulatory standards and ensures WPS delivers the highest value, competitive, and innovative provider solutions in the Wisconsin Market.

Salary Range
$150,000 ~ $180,000 annually
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

We are open to remote work in the following approved states: Illinois, Iowa, Minnesota, Wisconsin

How do I know this opportunity is right for me? If you:

• Enjoy leading, strategizing and developing a cross-functional team of Contracting Managers, Credentialing Manager, and specialists through coaching, performance evaluations, and succession planning.
• Can oversee the negotiation of various types of managed care contracts including capitation, fee-for-service, and value-based agreements with physicians, facilities and ancillary providers.
• Have managed the full contract lifecycle, including drafting, execution, maintenance, and termination.
• Like to partner with Senior leadership to identify and implement innovative contracting strategies.
• Can develop and implement initiatives to improve provider satisfaction and overall network performance.
• Are passionate about developing and negotiating complex provider and vendor contracts for products and services that include pricing and reimbursement methodologies, Medica-preferred terms and conditions, risk mitigation, and best-in-class service level performance agreements/guarantees while ensuring compliance with federal and state regulations.
• Can ensure alignment of corporate goals and compliance with performance expectations related to cost, utilization, quality metrics, member satisfaction, and network adequacy.
• Have managed and maintained strong business relationships with assigned providers; represent WPS in meetings with providers and participate in relevant community functions.
• can monitor the provider network to ensure it is sufficient for member needs and develop and implement strategies to address any gaps.
• Like to establish and maintain strong relationships with business partners to align on the strategic and tactical direction for provider and/or vendor negotiations.
• Excel at working closely with leadership to resolve Independent Dispute Resolution (IDR) issues, ensuring continuous compliance with evolving federal guidance related to the No Surprises Act and Qualified Payment Amount (QPA) calculations.
• Can coordinate health plan responses to contract audits and ad-hoc data requests.
• Have led and managed all aspects of the credentialing, re-credentialing, and provider enrollment processes for practitioners, aligning with federal, state, and accrediting body standards.
• Enjoy working with providers to resolve escalated issues related to contract terms and payments.

Minimum Qualifications

• Bachelor's degree in healthcare administration, business management or a relevant field or 10 plus years of equivalent work/educational experience
• 10 or more years of health plan work experience.
• 5 or more years in direct related work and leadership experience in contracting negotiations, provider relations, and/or network development functions.
• In depth understanding of healthcare reimbursement, relevant healthcare federal and state regulations and requirements this includes:
• Other experience required:
  
  
  
  • Strong critical thinking and analytical skills.
  • Exceptional leadership and team-building capabilities.
  • Excellent interpersonal and communication skills with the ability to influence and build relationships across various stakeholders.
  • Ability to identify, prioritize and drive work efforts with the highest returns on investment to achieve desired health plan goals.
  • Ability to work in a complex, rapidly evolving and deadline-driven environment with multiple internal and external stakeholders.
  
  
  
  

Preferred Qualifications

• 7 or more years of progressive leadership experience managing relevant health plan provider contracting and provider relations functions.
• Experience navigating Wisconsin Health Plan markets and networks.
• Strong experience using MS Excel and other Microsoft Office applications.

Remote Work Requirements

• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
• Please review Remote Worker FAQs for additional information

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs
• Review additional benefits: (https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml)

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.

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