Description
Job Summary: Oversees network and analytics strategy and execution for Delta Dental’s government business, including delivery of Medicaid and Medicare population health strategies. Directs matrix-oriented delivery model that ensures enterprise is delivering government-specific solutions unique to federal and state regulations.
Primary Job Responsibilities
1. Directs the daily activities of the team responsible for government programs network management, clinical performance, social determinants of health (SDOH), and the application of data analytics in maintaining optimal results.
2. Develops, recommends, and implements short and long term action plans in order to ensure the achievement of business unit goals.
3. Serves as leader in the development and monitoring of Medicare and Medicaid networks.
4. Establishes analytics function within the government programs business unit that is integrated into decision-making.
5. Communicates with and advises executive management on the planning and activities of government business.
6. Create and maintains governance of operational issues pertaining to government programs.
7. Supports business development efforts and serves as primary point of contact for network issues with clients.
8. Interviews, hires, evaluates, manages, and develops staff in order to ensure accountability for the achievement of departmental and individual goals and objectives.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Location
Delta Dental MI-Farm Hills-DDFH
Requirements
Position requires a bachelor’s degree with an emphasis in business administration or a related field, seven years of experience in Medicaid, Medicare, insurance and / or clinical operations, and three years of leadership experience.
Position requires experience in provider contract network development, management, optimization and familiarity of various provider compensation models including fee-for-service, capitation, value-based reimbursement, risk sharing, etc.
Position also requires advanced knowledge of the managed care industry, strong verbal and written communication skills; strong interpersonal skills; and the ability to resolve complex problems using independent judgment.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
Clipped from: https://recruiting.adp.com/srccar/public/RTI.home?c=1214201&d=TRI&rb=INDEED&r=5000670111306#/