The core business of Affinity Health Plan is to assure delivery of high quality, appropriate health care services to its enrollees. The purpose of this position is to assure effective integration and efficient operation of the company’s provider network functions, thus contributing to achievement of corporate goals and fulfillment of the corporate mission and vision. As a member of the Executive Staff, this position is expected to a) contribute to corporate-wide strategic and business planning, priority-setting and decision-making, and b) represent and express the values of the organization.
Provides leadership for the Network Management Division by a) clarifying performance expectations and assuring management accountability, b) delegating responsibility, authority and decision-making, as appropriate, c) contributing to development and implementation of strategies and tactics, d) using data, information, and analytical techniques to set priorities, make business decisions, and measure performance, e) promoting effective interdepartmental planning, analysis, and functioning, f) assuring compliance with all applicable laws, rules, regulations and contractual requirements, and g) mentoring and developing management staff.
Establishes vision, goals, objectives and performance expectations for the Network Management Division that are consistent with, and lead to the achievement of, corporate goals and objectives. Assures consistent goals, objectives and performance expectations in each of the functional units within the Division.
Assures that Network Management operations have adequate human, financial and technological resources to function effectively and efficiently. In so doing, analyzes, negotiates and recommends acquisition of appropriate technologies, systems, equipment and vendor services.
Assures effective daily management and integration of Network Management functions, i.e., network development, credentialing, provider information and reporting, provider relations, medical management, and related functions.
Assures the development, implementation and maintenance of operating policies and procedures within the Network Management Division that maximize productivity, fulfill quality standards, and comply with all applicable laws, rules and regulations.
Assures timely preparation of operating and capital budgets for all units of the Network Management Division, and assures optimal use of resources to achieve corporate and Divisional goals.
Serves as a member of the Executive Staff, sharing responsibility for, and contributing to, policy formulation, strategic direction, priority-setting, decision making, achievement of corporate goals, and overall leadership of the organization.
Develops and maintains positive, constructive, mutually beneficial relationships that promote the Affinity goal of being the “health plan of choice” for providers, consumers and purchasers.
Represents the company on appropriate local, State and national trade groups, government/industry workgroups and committees, and similar external venues.
Balchelor’s degree in related field, Masters degree in related field preferred.
Minimum of ten (10) years of relevant professional experience, preferably in a managed care plan or health care related enterprise.
Minimum of six (6) years of managerial experience at the department director/manager level. Evidence of progressive responsibility for multiple functions.
Extensive knowledge of business management principles and practices, and organizational policies and procedures.
Extensive knowledge of managed care structures and operations, including the interconnectivity of diverse and complex functions.
Working knowledge of each of the functions that are intrinsic to Network Management in a managed care plan, including knowledge of the human resources and technologies needed to function effectively.
Creativity and resourcefulness, demonstrated by ability to a) conceptualize new policies, programs and procedures, b) determine their feasibility, c) set priorities for self and others, c) identify and marshal needed resources, and d) achieve maximum functioning with available resources.
Advanced interpersonal and management skills, characterized by ability to a) listen, interpret and respond appropriately, b) mediate conflicting positions, c) consult, advise and influence in a persuasive manner, and d) manage diverse, complex relationships.
Ability to identify and use qualitative and quantitative information and data to make decisions and set priorities, while giving consideration to competing priorities and other perspectives within and outside the organization.
Ability to balance day-to-day operational issues and needs with corporate issues and needs.
Excellent writing and verbal communication skills, characterized by the ability to clearly articulate complex concepts.
Excellent analytical skills, demonstrated by the ability to identify and understand complex issues and problems, and compile and interpret information in a manner that provides appropriate direction and justifiable conclusions.
Excellent organizational skills, demonstrated by the ability to anticipate needs and prepare appropriately, and to organize and complete work efficiently and effectively.
Good judgment in a) seeking and using information to support decision-making, b) anticipating the consequences of decisions and actions, c) communicating information, d) interacting constructively with others both within and outside the organization, e) maintaining confidentiality, as appropriate, and f) choosing actions that are beneficial to, and consistent with, the mission, goals, culture and style of the organization.
Ability to take initiative, think independently, and contribute constructively to strategic planning, priority-setting and decision-making.
Must demonstrate a high degree of integrity, trustworthiness, respect for others, and ability to deal appropriately with confidential and sensitive information.
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