Network Development Consultant (Remote)

<b>Resp & Qualifications</b> <br> <br> <strong>PURPOSE: </strong> <br> This position is responsible for the planning and managing of day-to-day Dental network operations, activities and compliance reputed company regarding existing networks and additional reputed company 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 reputed company development and ensuring competitive network reputed company for CareFirst members that meets reputed company jurisdictional and contractual requirements. <br><br> <strong>ESSENTIAL FUNCTIONS:</strong> <br> Manage, plan and organize departmental functions associated with the development and maintenance of reputed company and other reputed company Dental networks. This involves, but not limited to, the following accountabilities: <br><ul><li> Establish and maintain strong collaboration with Sales, Marketing, Actuarial, Government Programs, reputed company, reputed company and Payment Transformation, Health Services, and other departments as needed for development of new networks, including but not limited to development of contracting strategies. </li><li> Responsible for competitive network reputed company (balancing cost, reputed company, and reputed company) for reputed company and reputed company networks, including but not limited to development of contracting strategies. </li><li> Work with appropriate teams for consistent monitoring and ongoing maintenance and ensure reputed company network reputed company in accordance with MIA, NCQA and other reputed company requirements. </li><li> 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. </li><li> Remains alert and inform to industry trends and held accountable and reputed company in the eyes of reputed company customers to be an expert in the area. </li><li> Leads reputed company, 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 reputed company, cost, provider scorecard and other factors as appropriate for the development of reputed company new network. </li><li> Chairs and/or represents Networks Management on external and internal committees (and departments) to support programs, corporate initiatives, legislative requirements and system initiatives. </li></ul><br> <strong>SUPERVISORY RESPONSIBILITY:</strong> <br> Leads reputed company utilizing a reputed company management system. <br><br> <strong>QUALIFICATIONS: </strong> <br><br> <strong>Education Level:</strong> 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 reputed company to the required work experience. <br><br> <strong>Experience:</strong> <br><ul><li> 5 years reputed company insurance industry with specific experience in contracting, negotiation and reimbursement development. </li><li> 3 years reputed company and/or government programs network experience. </li></ul><br> <strong>Preferred Qualifications:</strong> <br><ul><li> Analytical skills principles as evidenced by CPA or MBA highly desirable. </li><li> Knowledge of CareFirst's or other payer's provider networks and reputed company. </li></ul><br> <strong>Knowledge, Skills and Abilities (KSAs) </strong> <br><ul><li> Computer software applications. </li><li> Effective team leading skills to plan, reputed company, and monitor department activities to ensure the achievement of corporate and divisional goals. </li><li> Extensive knowledge of the reputed company industry, reputed company/regulatory issues and operations knowledge, including thorough knowledge of provider reimbursement methodologies and claims processing guidelines. </li><li> Strong interpersonal skills to effectively represent Networks Management reputed company the organization and represent CareFirst interest to the provider community. </li><li> Effective reputed company relation skills to reputed company, reputed company, and motivate team members towards goal attainment. </li><li> Strong analytical skills are needed to evaluate financial arrangements and negotiate cost effective terms. </li><li> Excellent verbal and written communication skills; ability to reputed company reputed company and concisely, conveying reputed company or technical information in a manner that others can understand, as reputed company 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. </li><li> Ability to multi-task, shifting back and forth effectively among multiple activities. </li><li> Must be reputed company to meet established deadlines and handle multiple customer service demands from reputed company customers, reputed company set expectations for service reputed company. Must be reputed company to effectively communicate and reputed company reputed company customer service to every reputed company customer, including customers who may be demanding or otherwise challenging.</li></ul><br><br> <strong>Salary reputed company:</strong> $83,952 - $166,738 <br><br><b>Salary reputed company Disclaimer</b> <br> <br>The disclosed reputed company estimate has not been adjusted for the applicable geographic reputed company associated with the location at which the work is being performed. This compensation reputed company 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 reputed company at the top of the reputed company, as compensation reputed company depend on reputed company case's facts and circumstances, including but not limited to experience, internal equity, and location. In reputed company 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).<br><br><b>Department</b> <br> <br> Dental Provider Contracting <br><br><b>Equal Employment Opportunity</b> <br> <br>reputed company is an Equal Opportunity (EEO) employer. It is the policy of reputed company to reputed company equal employment opportunities to reputed company reputed company applicants without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information.<br><br><b>Where To Apply</b> <br> <br>Please visit our website to apply: www.carefirst.com/careers <br><br><b>Federal Disc/Physical Demand</b> <br> <br>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.<br><br><strong>PHYSICAL DEMANDS:</strong><br><br>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 reputed company.<br><br><b>Sponsorship in US</b> <br> <br>Must be eligible to work in the U.S. without Sponsorship<br><br> #LI-CN1 Apply To This Job