Central Region Healthcare Provider Network Lead Analyst

LOCATION: REMOTE position aligned to the Central Region States of the USA

The Central Region Healthcare Provider Network Lead Analyst serves as an integral member of the Network Development and Competitive Insights Team within Network Operations and Provider Contracting and reports to the Northeast Regional Network Access Lead.

This role is responsible for leading regional product specific projects and/or components of larger national projects for the Northeast and Central regions.

Responsible for managing the analyst team through review and coordination of all recruitment projects.

Identifies proactive recruitment opportunities and manages the review and approval for all incoming recruitment projects.

Responsibilities include the evaluation of project objectives/requirements, system requirements, the development of procedures/processes/policy solutions to address the complex business needs as well as adherence to state contracting and compliance guidelines.

May direct one or more teams of business matrix partners to achieve project goals.

Manages the hospital/large group and/or significant provider termination management process in assigned markets for Commercial and IFP products.

Works closely with Contracting, Network Solutions, Network Operations, Provider Services, Sales and Compliance to meet termination process management guidelines/state requirements.

Prepares competitive network benchmarking and industry comparative analysis to support Commercial and IFP products.

RESPONSIBILITIES:


* Manage new hire and existing analyst training as needed (technical skills and workflows).

This includes the creation and maintenance of department workflows and related training documentation.


* Identify proactive recruitment projects and manage review and approval of all incoming recruitment projects.

This relates to projects regarding: filling network adequacy gaps for all products, compliance filings and gap requirements, national account/middle market client specific requests, regional access builds, Essential Community Providers, TPV and/or Alliance partner conversion to direct networks or partner replacement.

Includes managing the analyst team on project review/coordination with required matrix partners and reporting requirements to matrix partners and upper management regarding status.


* Work closely with Network Access Lead to support/provide required analysis work to map out required recruitment efforts/strategy to replace Third Party Vendors (TPV) in specific geographies and/or Alliance Partner replacements as required.


* Manage and track approved TPV conversions and/or Alliance Partner replacement projects in the Northeast and Central regions.

This includes working directly with Market Deployment Managers and identifying project scope, managing specialty vendor recruitment/access in related geography, working directly with Contracting on market specific contracting activities to track completion and/or gaps to ensure ne...