Director, Network Development
Location: Milwaukee, Wisconsin, United States
Remote Opportunity: 1
Requisition Number: 2322
Position Title: Director, Network Development
The Director, Network Development will recruit and build high performance networks, for all dental product lines of business, meeting or exceeding DentaQuest and client goals. Specifically, the Director will provide strategic analysis and proven leadership skills to develop and implement all aspects of network development from build and contract, to quality and cost measurements. Network goals will be focused at the national level, as well as the local level, and will include Medicaid, Commercial, Exchange/HIX, and Medicare Advantage (including Duals). All programs will tie to the organization’s national network strategy supporting all dental products.
- Develop and implement complex network plans, including various payment methodologies, from fee-for-service to value-based reimbursements, for dental providers. Make recommendations on new payment methodologies that link quality and price to reduce cost of care and improve outcomes.
- Develop provider strategy to support contracting and network development efforts. Incorporate knowledge of federal and state guidelines and contract requirements into overall network plans. Develop and implement detailed contract negotiation strategies, including some face-to-face negotiations with provider leaders on multiple types of reimbursement methodologies. Builds relationships that strengthen provider partnerships and value-based business opportunities to support the local market strategy.
- Employ payer / provider negotiation techniques, including the contract negotiation, provider renewals, to build and maintain strategies, including the foundational principles of provider-oriented management of risk share and provider incentive value-based payment pools.
- Lead research and development efforts around competitive networks. Understand network composition and provider reimbursement for all markets and build plans to align DentaQuest’s networks to remain competitive, achieving goals of the dental program, aligning cost and access needs.
- Incorporate DQ’s Care Delivery strategy into the overall network plans to support quality and cost market goals.
- Lead Network Development team to effectively execute program network plans. Ensure team is sourced and trained to effectively negotiate agreements from fee-for-service to value-based payment models. Oversee provider contract development for all provider agreements.
- Oversee key national provider groups (DSOs) with complex network systems to influence and support network goals for all dental products. Ensure contracts and programs align with local and national goals.
- Lead effort for the network plan including network composition, provider contracting, fee creation, and credentialing to effectively build networks that meet cost, quality and compliance requirements.
- Optimize multiple networks through stacking technology to maximize network composition and price.
- Work closely with VP, Network Development on leased network strategy; conduct contract negotiations with leased networks to build effective partnerships to support new dental programs.
- Proactively anticipate and make recommendations to resolve key operational or functional gaps that would prevent the successful implementation of a provider network or product strategy.
- Analyze financial, network disruption, GEO access reporting and operational report data to drive improvements in the network contracting and payment implementation process.
- Identify new opportunities or services to enhance the capabilities of the Network Development team.
- Understand the latest industry trends around dental markets and reimbursement within multiple markets. Work independently with minimal direct supervision
- Perform other duties, as assigned
- Bachelor's degree in business, healthcare administration or related field required.
- 8+ years of experience in healthcare network development/ contracting understanding of network adequacy strategies
- 5+ years of experience in contract and reimbursement development, including payment innovation, performance management of provider networks, ACOs, capitation, risk share, etc.
- Medicaid and Medicare Advantage working knowledge on federal and state regulations
- Experience with Value-Based Care agreements
- Large and complex project leadership experience
- Managerial experience with remote staff.
- Solid analytical and presentation skills, including advanced PowerPoint and Excel experience
- PHYSICAL DEMANDS:
- Incumbent must be able to communicate effectively.
- Requires overall light physical effort (up to 25lbs.)
- Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal compute).
- Ability to travel or move about within and outside serviced facilities required.
- Incumbent works primarily in either a private or shared office environment.
- Approximately 30% travel required.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform this position.
** In accordance with DentaQuest’s Compliance Plan, employee must conduct DQ business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or DQ’s Compliance Officer. **
Community / Marketing Title: Director, Network Development
At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.
Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.
Location_formattedLocationLong: Milwaukee, Wisconsin US
CountryEEOText_Description: Equal Employment Opportunity Statement: DentaQuest is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, sex, age, disability, marital status, or sexual orientation.