Director - Network Development

2 days ago

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

💵 $113.5k - $220.4k / year

⏰ Full Time

🔴 Lead

👔 Director

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Dominion National

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Dominion National is your trusted choice for the Federal Employee Dental and Vision Insurance Program (FEDVIP). They offer a range of Exclusive Provider Organization (EPO) dental plans specifically designed for federal employees and TRICARE retirees, focused on providing cost-effective dental care and additional wellness benefits. Members enjoy features such as price transparency, flexible coverage options, tele-dentistry services, and rewards for preventive care, ensuring optimal oral health without the burden of annual maximums or waiting periods.

Dental Benefits • Vision Benefits • Dental Insurance

201 - 500 employees

Founded 1996

⚕️ Healthcare Insurance

💸 Finance

👥 B2C

📋 Description

• Responsible for the direct expansion, maintenance and quality of the organization’s dental provider network activities. • Ensure provider relations program’s policies, procedures and regulations meet the needs of Dominion National and its members, as well as state and federal requirements. • Work with the Senior Team, Colleagues and Staff to develop the Annual Network Development Plan. • Responsible for the execution and success of the Plan. • Effectively lead and manage recruitment and administration team. • Develop recruitment plan with leadership and sales to target and prioritize recruitment areas including expansion opportunities. • Direct Provider Development Managers and staff to meet targeted recruitment goals. • Act as liaison between Network Development and various Dominion administrative departments. • Responsible for provider compliance with state and federal regulations. • Oversee complaint processes and procedures. • Maintain current knowledge of industry and technical issues through participation in seminars, workshops and publications. • Identify and recruit providers as necessary to ensure the development of a provider network compliant with CMS network adequacy and other entity requirements. • Coordinate with Actuarial, Finance and the Senior Team the review and development of provider fee schedules. • Ensure provider demographic and rate related information is captured and properly loaded in all Dominion systems consistent with company policy. • Recruit, manage/oversee the training of new employees, as well as developing and applying appropriate policies and procedures for Network Development activities, including compliance. • Direct the ongoing operations of the Provider Network and ensure adherence to all performance metrics. • Build strong relationships with providers.

🎯 Requirements

• Understanding of and relevant experience in commercial and Medicare populations and lines of business. • Proven effective communications skills (verbal, written, presentation) with all types and levels of audiences. • Proficiency with MS Office applications (word processing and database/spreadsheet). • Excellent analytic, interpersonal, project management, negotiation and leadership skills. • Critical thinking, problem-solving and collaborative team-player mindset. • Confidence in taking ownership of work processes with only high-level direction and guidance • Ability to lead people and inspire them to do their best. • Knowledge of reimbursement principles and state and federal Medicare/Medicaid financing rules and regulations. • Requires minimum of 7 years' dentist recruitment focused on the Group Health/Dental fields. • May consider 11 years' experience in lieu of a degree. • Minimum of 3 years' experience at a health plan in a managerial or higher position preferred. • Proven ability to effectively manage in a matrix organization. • Previous experience with implementation and expansion of a health plan business unit or division.

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Generous time off including Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • More