Hybrid Executive Director, External Provider Management

at Northwest Permanente

• Job title: Executive Director, External Provider Management
• Job type: Full Time
• Experience level: Lead
• Salary: Not specified
• Degree requirement: Postgraduate Degree
• Location requirements: Hybrid, Portland, United States

About the role

• Executive Director of External Provider Management overseeing provider network and contract management for Northwest Permanente. Collaborating across Kaiser Permanente to achieve high quality healthcare outcomes.

Responsibilities

• Collaboratively ensures the Northwest Permanente’s Provider Network Management is a proactive leader in the industry through internal and external monitoring and benchmarking and refinement of business strategies to reflect current and anticipated market conditions.
• Shares knowledge internally to inform strategies and plans leveraging best practices.
• Develops and implements governance structures, performance dashboards, and strategic roadmaps to monitor and improve service, quality, utilization, and overall network stability.
• Ensures compliance with all applicable contractual and regulatory requirements, including oversight of corrective action planning, implementation, and timely resolution of inquiries and complaints.
• Monitors network performance and approves business and communication solutions to address process, quality, and compliance gaps.
• Serves as directing sponsor for network management system capabilities, guiding implementation strategy and multi-year technology roadmaps.
• Partners with the Kaiser Permanente Health Plan in facilities and professional contracting administration - partnerships may include sales/marketing, regional care delivery, and national stakeholders to design network strategies aligned with geographic and service line objectives.
• Conducts strategic assessments of external networks to identify opportunities for expansion or modification, with attention to cost, coverage, and market growth.
• Partners with senior leadership in contract negotiations with professional, hospital, health system, and network providers to include overseeing negotiations and contract discussions.
• Ensures the organizational network 1) augments and supports the care delivery system to meet members’ needs for high quality care, remedying any care delivery gaps 2) meets network competency, network adequacy, and regulatory compliance, 3) achieves market competitiveness and affordability, and 4) meets and enhances overall reputational, strategic, and business objectives.
• Provides leadership in mentoring and developing direct reports and staff in a manner that emphasizes the importance of teamwork, collaboration, and the sharing of information, resources, and best practices.
• Facilitates overall supervision, leadership, and guidance to direct reports, including responsibility for hiring, performance evaluation and management, development, and termination, in accordance with organizational policy.

Requirements

• Master’s degree in finance, business administration, healthcare, legal, or related field or equivalent education and experience.
• Minimum fifteen (15) years’ experience managing businesses, healthcare administration or related field with a focus in strategy development, network operations/management, provider relations or contract design/negotiation, including the financial management, budget development, program development of projects/programs.
• Minimum ten (10) years of progressive management experience with at least three (3) of those years at a senior leader or director level.
• Management experience to include oversight of the administration of provider contracting, provider data management, network management.
• Experience leading complex programs or projects requiring the integration of cross-functional business and technical teams to deliver business solutions.
• Strong understanding and experience in business case development, workflow analysis, including the use of modeling software (e.g. Visio).
• Strong understanding of systems that enable provider data management, network design, reimbursement models and episode analytic platforms.
• Working familiarity with various managed healthcare provider compensation methodologies, including but not limited to: fee-for service, capitation and various forms of risk, ASO, etc.
• Familiarity with CMS 5 Star, HEDIS, Risk Adjustment, and other Pay for Performance Programs preferred.

Benefits

• 15% employer contribution to retirement programs, including pension
• 90% employer-paid health plan
• Tuition Reimbursement
• Child Care Benefits
• Flexible Work Schedules
• Paid Parental Leave
• Self-Care Days + Paid Time Off