Provider Network Director jobs in North Dakota

Provider Network Director directs and develops a healthcare provider network. Designs and administers policies and services that comply with all contractual and regulatory requirements. Being a Provider Network Director requires a bachelor's degree. Typically reports to top management. The Provider Network Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Provider Network Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

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VP of Provider Network Strategy
  • Blue Cross Blue Shield of North Dakota
  • Fargo, ND FULL_TIME
  • All about us

    You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.

     

    We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

     

    Work environment

    This opportunity is eligible for an in-office work arrangement based out of our Fargo, ND office, with flexibility to work remotely 1-2 days/week. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.

    This position is eligible for internal and external applications. 

     

    Pay information

    • Opportunities for continued salary growth through performance-based incentive programs.
    • FLSA Category: Exempt-Salaried
    • Pay Level: C

     

    A day in the life

    The VP of Provider Network Strategy is responsible for providing leadership, direction and guidance to the provider contracting,  provider network performance and provider operations teams within the division. This position is accountable for the development of strategic provider networks including development of new strategic partnering relationships through fee-for-service and value-based contracts, supported by provider reimbursement methodologies and network strategies that improve overall health care affordability, access, quality, and experiences for our members.  This is supported through coordination across the organization and in interaction with providers to plan and implement network development activities and resources to meet corporate business goals.

     

    Your responsibilities will include

    • Directs, leads and oversees staff in accomplishing work objectives within the unit(s). Coaches, motivates, rewards and recognizes subordinates. Sets clear goals, objectives and performance expectations and holds employees accountable for achieving results.
    • Delivers collaborative strategic leadership within the division in setting long and short-term goals.
    • Oversees development, implementation, and leadership for areas of responsibility to ensure the organization delivers affordable, value-based medical and pharmacy products to customers and achieves the most competitive and effective health networks in each market segment.
    • Oversees the provider contracting function to achieve strategic contracting goals with providers, including core participation agreements in fee for service reimbursement methodologies and value-based agreements in fee for value reimbursement methodologies for all lines of business.
    • Collaborates within the organization to drive development of reimbursement methods and quality programs that shape behavior and performance of provider networks for the benefit of our member population and customer groups.
    • Oversees the development and management of provider networks, including provider performance based network strategies to improve overall health care affordability and member experience, and the planning and implementation of provider network activities and resources through provider data analytics, financial analyses, competitive intelligence, market research, population health informatics and medical cost trend analyses.
    • Fosters effective leadership to achieve the best customer experience possible for members, providers, staff, employer groups, the Association, and other constituents, as well as promoting and furthering corporate goals relative to areas of responsibility.
    • Partners with and educates regulators, politicians, board members, policymakers, associations, state officials, community leaders, providers and various influential representatives of the healthcare community on the merits and effects of healthcare policy and practice.

     

    What you need to succeed

    • A Bachelor's degree in Business, Healthcare, Finance, or related.
    • 10 years of healthcare, insurance industry or related experience with a deep understanding of the provider landscape.
    • 7 years of supervisory/staff leadership experience with a proven ability to provide strategic leadership to a director-level team.
    • Ability to provide direction and execute on divisional initiatives tied to provider performance and contracting.
    • Comfortable presenting material to executive leadership, as well as other audiences across the organization.
    • Desire to learn the business and cross-collaborate with internal teams and our provider groups.
    • Advanced communication and interpersonal skills, navigating the work with resilience and tenacity. 

       

      Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

       

      Benefits and perks

      • Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
      • Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
      • 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
      • Employee recognition, community initiative events and yearly company outings.
      • Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
      • Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.

       

      Equal opportunity employment

      Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

      For questions, please email careers@bcbsnd.com.

      This job posting will be closed on 6/7/2024 at 8:00 a.m. (CT). No further applications will be considered.

    • 20 Days Ago

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    QA Utilization Management Review Lead
    • Provider Resources, Inc.
    • Grand Forks, ND FULL_TIME
    • Position Description: QA Utilization Management Review Lead Reporting to the Project Manager/IQIP Manager, the QA Utilization Management Review Lead provides day-to-day supervision of the QA Utilizati...
    • 4 Days Ago

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    Medical Review Nurse
    • Provider Resources, Inc.
    • Fargo, ND FULL_TIME
    • Position Description: Medical Review Nurse Reporting to the Medical Review Manager (MRM), the Medical Review Nurse will provide professional assessment, planning, coordination, and implementation and ...
    • 19 Days Ago

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    Quality Assurance Manager
    • Provider Resources, Inc.
    • Fargo, ND FULL_TIME
    • Position Description: Quality Assurance Manager Under the direction of the Program Manager for the Independent Dispute Resolution Entity (IDRE) or their delegate, the Quality Assurance Training Manage...
    • 23 Days Ago

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    Quality Review Nurse
    • Provider Resources, Inc.
    • Fargo, ND FULL_TIME
    • Position Description: Quality Assurance Review Nurse Reporting to the Director, the QA Review Nurse will provide professional assessment, planning, coordination, implementation and reporting of comple...
    • 29 Days Ago

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    Quality Review Nurse
    • Provider Resources, Inc.
    • Grand Forks, ND FULL_TIME
    • Position Description: Quality Assurance Review Nurse Reporting to the Director, the QA Review Nurse will provide professional assessment, planning, coordination, implementation and reporting of comple...
    • 30 Days Ago

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    Audit Director, Payments Network (Hybrid)
    • Capital One
    • New Haven, CT
    • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
    • 6/10/2024 12:00:00 AM

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    Audit Director, Payments Network (Hybrid)
    • Capital One
    • Atlantic City, NJ
    • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
    • 6/10/2024 12:00:00 AM

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    Audit Director, Payments Network (Hybrid)
    • Capital One
    • Washington, DC
    • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
    • 6/10/2024 12:00:00 AM

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    Audit Director, Payments Network (Hybrid)
    • Capital One
    • Dover, DE
    • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
    • 6/10/2024 12:00:00 AM

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    Audit Director, Payments Network (Hybrid)
    • Capital One
    • Charlottesville, VA
    • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
    • 6/10/2024 12:00:00 AM

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    Audit Director, Payments Network (Hybrid)
    • Capital One
    • Fredericksburg, VA
    • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
    • 6/10/2024 12:00:00 AM

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    Audit Director, Payments Network (Hybrid)
    • Capital One
    • Richmond, VA
    • NYC 299 Park Avenue (22957), United States of America, New York, New York Audit Director, Payments Network (Hybrid) Capi...
    • 6/10/2024 12:00:00 AM

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    Director of Networking
    • Insight Global
    • Director of Network Services and Engineering Must be in Nashville, TN - Hybrid schedule of 3 days onsite Requirements: 1...
    • 6/7/2024 12:00:00 AM

    North Dakota is a Midwestern state of the United States. It borders Canada and lies at the center of the North American continent. The geographic center of North America is near the town of Rugby. Bismarck is the capital of North Dakota, and Fargo is the largest city. Soil is North Dakota's most precious resource. It is the base of the state's great agricultural wealth. But North Dakota also has enormous mineral resources. These mineral resources include billions of tons of lignite coal. In addition, North Dakota has large oil reserves. Petroleum was discovered in the state in 1951 and quickly...
    Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
    Income Estimation for Provider Network Director jobs
    $172,532 to $222,903

    Provider Network Director in Columbus, OH
    In either scenario, taking these three steps can help you determine whether a network change will genuinely lower your costs.
    February 09, 2020
    Provider Network Director in Portland, ME
    We offer providers a value-based reimbursement model centered on aligning quality measures, HEDIS measures and HH incentives to reward high-quality care of the members you serve.
    December 12, 2019
    Provider Network Director in Temple, TX
    However, from a state regulator’s and the health plan’s perspective, the sheer number of providers in the network overall is only part of the story.
    December 21, 2019