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Senior Director Provider Account Management, Geisinger Health Plan (work from home Pennsylvania resident)

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Job Title Senior Director Provider Account Management, Geisinger Health Plan (work from home Pennsylvania resident) Location Work from Home Job Category Health Plan Administration, Geisinger Health Plan Schedule Days Work Type Full time Department Office of the GHP Chief Medical Officer Date posted 11/23/2022 Job ID R-41284

Job Summary

​Provides overall accountability for Account Management functions including negotiation and ongoing provider network servicing. Provides leadership in the development of departmental strategic plans, budgets, and forecasts. Provides guidance and assistance to management in the administration and execution of strategic goals. Develops overall strategy and goals in conjunction with management and leadership, by providing continuous, innovative leadership and direction to the development and ongoing monitoring and maintenance of relationships. Shapes and executes development of preferred provider relationships between the Health Plan and network providers/ACOs. Develops and manages initiatives that drive expanded business opportunities, programmatic growth and innovation.

Job Duties

  • Develops positions and insight documents that articulate the pros and cons of different courses of action/options for potential or existing preferred provider relationships.
  • Develops formal strategies to maximize the success of existing or new potential preferred provider relationships.
  • Conceptualizes, builds and launches programs through preferred providers and network, from product conception to go-to-market plans, ensuring the best product experience for preferred providers in the network.
  • Manages the development and maintenance of the health plan provider network to include selection of providers and either direct or oversight of negotiation/renegotiation of contacts with providers.
  • Manages contractual relationship between Geisinger Health Plan and multiple partnerships.
  • Oversees the Unit Cost position with all contracted providers.
  • Develops and drive the strategy, solutions and growth of the health plan and accountable for formulating the long-term strategy and building/integrating the provider network
  • Mobilizes and manages teams of individuals charged with executing strategies.
  • Oversees the management and development of the provider network to meet Strategic System goals, Sales and Marketing goals and projections, including:

  • Negotiation or oversight of negotiation of complex contracts with hospitals and preferred provider groups.
  • Development of the next generation of Pay for Performance
  • Determination of the most appropriate size, composition and geographic distribution to meet all regulatory standards, cost optimization and quality strategies and member needs.
  • Ensures communication across all functional areas.
  • Ensures adherence of contractual commitments.

  • Participates in the design, development, and implementation of automated reporting mechanisms that are specifically focused on the overall unit cost performance of the department and are easily utilized by the account management staff.
  • Develops and implements cost, quality and reimbursement strategies into strategic network development plans to ensure development of a high performing physician network and preferred provider relationships.
  • Develops and leads the re-engineering of current processes throughout the department with a focus on maximizing efficiencies and promoting automation.
  • Ensures the ongoing satisfaction and long-term retention of providers. Develops and adjusts recruitment strategies as necessary. Facilitates ongoing problem solving and serves as a resource to interpret and clarify contract related questions and administrative issues.

Position Details

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Education

Bachelor's Degree-Related Field of Study (Required), Master's Degree- (Preferred)

Experience

Minimum of 10 years-Related work experience (Required), Minimum of 5 years-Managerial/Supervisory (Preferred)

Skills

Provider Management; Leadership; Insurance Industry; Critical Thinking; Communication; Building Relationships

About Geisinger

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

Our Commitment to Diversity, Equity and Inclusion

Geisinger values who you are, where you are from, and where you are going. We seek out people of various backgrounds and cultures with unique abilities, non-traditional career paths and ambitious aspirations. We are an Affirmative Action, Equal Opportunity Employer. Women and Minorities are encouraged to apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status. Read more about Our Commitment to Inclusive Recruiting.

Our Vision & Values

Everything we do is about making better health easier for our patients, our members, our students, our Geisinger family and our communities.

KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.

EXCELLENCE: We treasure colleagues who humbly strive for excellence.

LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.

INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.

SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

Our Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.

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