Job Description

Compassion. Accountability. Collaboration. Foresight. Joy. These are the Aspirus Core Values; and we are looking for the BEST around to join us as we demonstrate those values Every. Single. Day. Aspirus in Wausau, WI is seeking a DIRECTOR- HEALTH PLAN NETWORK MANAGEMENT to join our ASPIRUS HEALTH PLAN team! This position is responsible for developing and implementing the methodology which results in competitive contract pricing while maintaining a broad network of hospitals, physicians, behavioral health and ancillary providers.Monitors and supports all AHP contracting efforts for implementation, compliance, and reimbursement.Directing and overseeing staff responsible for contracting, provider relations activities, network directories, provider/facility database and reporting.Utilize tools and resources to actively optimize pricing and access to care for AHP. Establishes positive working relationships with all AHP members and contracted providers to effectively serve as the primary point of contact for network performance. Experience/Qualifications Bachelor’s degree 10 years health care or health insurance experience to include 4 years contract administration and facility or provider relations experience OR 14 years of health care or health insurance experience to include 4 years contract administration and facility or provider relations experience. 4 years management experience including hiring, performance management, change management and professional development. 10 years health care or health insurance experience to include 4 years contract administration and facility or provider relations experience OR 14 years of health care or health insurance experience to include 4 years contract administration and facility or provider relations experience 4 years management experience including hiring, performance management, change management and professional development Experience in P4Q and VBP contracting with multiple products Ability to build access to care and negotiate contracts with new providers Leadership skills Financial acumen, experience with oversight of budget, and experience with financial managed care contracting Knowledge of facility/provider contracting methodologies and pricing strategies and the facility or provider community Negotiation, contracting skills and analytical and strategic thinking skills Verbal and written communication skills Proficiency in Microsoft Word, Outlook, and PowerPoint, as well as database management, e.g., Microsoft Excel and Access preferred. Basic medical terminology knowledge Working with providers on contract or claim experience Health insurance plan or managed care experience preferred Requires an individual who is self-motivated, self-directed and assumes responsibility over assigned work functions, accuracy, and ability to prioritize work to meet specified timeframes. Basic group presentation skills are beneficial, with the ability to communicate with administrators and physicians and different levels of management important. Possesses good oral and written communication skills. Strong customer service skills. Is detail oriented. Annualcompetencies as required by Aspirus and/or various regulatory agencies based on entity and/or job position. Employee Benefits Full benefits packages available for part- and full-time status. PTO accrual from day one! Generous retirement plan with match available. Wellness program for employees and their families. Aspirus Wausau Hospital is the flagship of the Aspirus system that serves patients in 14 counties across northern and central Wisconsin, as well as the Upper Peninsula of Michigan. It is a licensed private/not-for-profit facility with 325 beds and staffed by 350 physicians in 35 specialties. Aspirus Wausau Hospital is a Level II trauma center that provides primary, secondary and tertiary care services as a regional referral center. Specialty referral service emphasis exists in cardiology and cardiothoracic surgery, orthopedics and cancer. The hospital has an average daily inpatient census of 220 with approximately 15,000 admissions per year. Outpatient visits exceed 50,000 and there are also more than 24,000 annual emergency department visits. To learn more about Wausau click the following link: Wausau, Wisconsin Best known for its world-class cardiovascular program, Aspirus Wausau Hospital also provides leading edge cancer, trauma, women's health, and spine and neurological care. Our Mission : We heal people, promote health and strengthen communities. Our Vision : Aspirus is a catalyst for creating healthy, thriving communities, trusted and engaged above all others. As an Aspirus team, we demonstrate caring, we plan to impact the future, work with happiness and enthusiasm, recognize our power to make a difference and improve the health of our communities. Aspirus Health is a nonprofit, community-directed health system based in Wausau, Wisconsin, serving northeastern Minnesota, northern and central Wisconsin and the Upper Peninsula of Michigan. The health system operates 19 hospitals and 130 outpatient locations with nearly 14,000 team members, including 1,300 employed physicians and advanced practice clinicians. For more information visit aspirus.org. Click here to learn more. Credentials: #J-18808-Ljbffr Aspirus, Inc

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