Manager, Network Development

Responsibility for overall Management of the Internal Network Development Coordinators and projects within the Network Development department. Assist the Director of Network Development with strategic review and planning of various projects and objectives within the Network Development department. Capable of managing strategic programmatic initiatives as assigned. Assists in contract negotiations with individual providers, provider groups, hospitals and other ancillary providers. Coordinates work flow and assessing process for completion of projects involving the claims system, ensuring the accuracy of provider demographic information in various databases, coordination of all credentialing activities including oversight and coordination when credentialing is delegated to an outside entity. Works closely with the Director of Network Development to assist in the implementation of new programs or projects within Cook Childrens Health Plan.

Education & Experience:

• Bachelors degree required.
• Seven (7) years of operational experience in a managed care organization specifically in the area of provider network management, contracting and contract negotiations, claims systems, problem resolution and provider communications required.
• Incumbent must demonstrate proven success in establishing and maintaining positive working relationships with health care providers and their staffs.
• Strong supervisory experience in leading and directing the work of others.
• Working knowledge of HMO business operations specifically the functions of utilization management, member services, claims, credentialing and benefit plan interpretation.
• Experience preparing and presenting information to individuals and groups.
• Must be attentive to detail, have excellent organizational, problem solving, verbal and written skills.
• Must be able to work independently and actively participate as an integrated team member.
• Experience with governmental managed care programs preferred.
• Willingness to continuously improve skills in database and related applications.
• Willingness to continuously improve knowledge base in both health care and provider contracting and management.

Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer.