Sr Network Development Executive

Sr Network Development Executive

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

Job Summary
This position is responsible for identifying and evaluating opportunities in support of network-based solutions by negotiating optimal reimbursement rates and drafting contracts for network and non-network providers to support commercial and government products. This activity will ensure patient access to the highest quality, cost-effective providers of healthcare services in accordance with applicable regulations and the Company's policies, practices, and procedures.

In addition, this position is responsible for working with management in the aggressive execution of regional strategies based on market trends and client expectations, as well as continuous evaluation of assigned territory penetration and discounts. This role may support other areas such as Payment Integrity and Analytics-Based Services.

Key Responsibilities

• Assist management in the identification and development of contracting priorities for assigned territory to support Network Development provider contracting initiatives
• Negotiate provider contracts to support penetration and discount objectives relative to competitive market trends and client expectations through comprehensive, aggressive execution of region-specific contracting goals
• Foster and maintain superior provider relationships, including management of the business relationship with large, complex providers
• Respond to provider questions, issues, and problems that have been appropriately escalated and produce a solution
• Conduct complex internal audits and reviews of existing provider relationships and supporting documentation to resolve internal or external inquiries
• Function as provider-specific expert by identifying, understanding, and documenting strategic business needs and market strategies
• Maintain, and preferably exceed, contracting production and quality standards consistent with established regional goals
• Prepare analyses, reports, and presentations by collecting, analyzing, and summarizing information and trends
• Monitor, compare, and contrast market competitive information to develop and initiate growth strategies and assess network adequacy and marketability
• Serve as mentor to less experienced Provider Contractors through ongoing instruction, coaching, modeling, and counseling
• Work with Sales and Account Management to respond to and anticipate access requirements and network-related performance guarantees
• Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement strategies
• Collaborate, coordinate, and communicate across disciplines and departments
• Develop and maintain positive relationships at all levels within the organization and communicate provider needs to applicable process owners
• Ensure compliance with established policies and procedures and regulatory requirements (including but not limited to HIPAA)
• Complete mandatory training requirements, including Human Resources, product orientation, and contracting tools and resources
• Demonstrate Company's Core Competencies and values
• Perform other duties as assigned

Job Scope
The incumbent is considered to be a senior staff professional who applies comprehensive knowledge of principles, practices, and procedures related to the completion of complex or difficult negotiation and maintenance of provider network contracts.

This role works independently and has substantial latitude for unreviewed action or discretion and may have authorization to act outside standardized procedures. The incumbent may assist less experienced Provider Contractors in resolving complex issues and may act in a liaison capacity with other departments.

This position does not directly manage others but may provide project or work direction to less experienced team members. The role may require overnight travel to meet with providers in assigned geographic areas and/or attend company-sponsored meetings and events.

The incumbent will possess the skills necessary to strategize, construct, and negotiate complex financial rate structures and contract language and demonstrate successful negotiations requiring this skill set.