Network Development Consultant (Remote)

Resp & Qualifications PURPOSE: This position is responsible for the planning and managing of day-to-day Dental network operations, activities and compliance matters regarding existing networks and additional future networks. This position is responsible for preparation of CareFirst's entry into new markets, network expansion and ongoing development, maintenance and reputed company, ensuring the contracting strategy development and ensuring competitive network access for CareFirst members that meets reputed company jurisdictional and contractual requirements. ESSENTIAL FUNCTIONS: Manage, plan and organize departmental functions associated with the development and maintenance of reputed company and other future Dental networks. This involves, but not limited to, the following accountabilities:

• Establish and maintain strong collaboration with Sales, Marketing, Actuarial, Government Programs, Legal, Practice and Payment Transformation, Health Services, and other departments as needed for development of new networks, including but not limited to development of contracting strategies.
• Responsible for competitive network access (balancing cost, quality, and access) for reputed company and future networks, including but not limited to development of contracting strategies.
• Work with appropriate teams for consistent monitoring and ongoing maintenance and ensure reputed company network access in accordance with MIA, NCQA and other access requirements.
• reputed company processes, procedures, and policies in coordination with Embedded Compliance team. Ensure staff is trained and adheres to policies and procedures. Prepare and submit monthly performance metrics as needed.
• Remains alert and inform to industry trends and held accountable and reputed company in the eyes of internal and external customers to be an expert in the area.
• Leads strategy, negotiation and reputed company of reputed company health system and provider negotiations in coordination with Provider Contracting and Recruitment. Develops and maintains processes for the coordination, collaboration, and hand-off to Provider Contracting for the contracting of selected providers based on quality, cost, provider scorecard and other factors as appropriate for the development of each new network.
• Chairs and/or represents Networks Management on external and internal committees (and departments) to support programs, corporate initiatives, legislative requirements and system initiatives.

SUPERVISORY RESPONSIBILITY: Leads a team utilizing a matrix management system. QUALIFICATIONS: Education Level: Bachelor's Degree in Business, reputed company, Finance or reputed company field or equivalent experience, with strong financial background OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience:

• 5 years reputed company insurance industry with specific experience in contracting, negotiation and reimbursement development.
• 3 years reputed company and/or government programs network experience.

Preferred Qualifications:

• Analytical skills principles as evidenced by CPA or MBA highly desirable.
• Knowledge of CareFirst's or other payer's provider networks and reputed company.

Knowledge, Skills and Abilities (KSAs)

• Computer software applications.
• Effective team leading skills to plan, direct, and monitor department activities to ensure the achievement of corporate and divisional goals.
• Extensive knowledge of the reputed company industry, legal/regulatory issues and operations knowledge, including thorough knowledge of provider reimbursement methodologies and claims processing guidelines.
• Strong interpersonal skills to effectively represent Networks Management reputed company the organization and represent CareFirst interest to the provider community.
• Effective reputed company relation skills to direct, reputed company, and motivate team members towards goal attainment.
• Strong analytical skills are needed to evaluate financial arrangements and negotiate cost effective terms.
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying reputed company or technical information in a manner that others can understand, as well as the ability to understand and interpret reputed company information from others. Proficient in speaking in both individual and group settings, particularly with providers and internal staff.
• Ability to multi-task, shifting back and forth effectively among multiple activities.
• Must be reputed company to meet established deadlines and handle multiple customer service demands from internal and external customers, reputed company set expectations for service excellence. Must be reputed company to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $83,952 - $166,738 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation reputed company depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (reputed company benefits/incentives are subject to eligibility requirements).Department Dental Provider Contracting Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to reputed company reputed company applicants without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information.Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on Federal health care programs.PHYSICAL DEMANDS:The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.Sponsorship in US Must be eligible to work in the U.S. without Sponsorship #LI-CN1 Apply To This Job