Director, Network Relations

  • 19645 Northchase Dr, Houston, TX 77060, USA
  • Full-time

Company Description

HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.

Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.

WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.

Job Description

·         Manages a team of Network Relations Consultants to ensure timely resolution of payer and/or provider escalations

·         Ensures adherence to well-organized operational processes designed to reduce the time needed to effectively research and implement solutions

·         Partners with Client Managers to ensure all operational payer and/or provider issues are properly defined in an effort to streamline completion and mitigate rework

·         Ensures team actively participates in client meetings (as needed) to provide status updates regarding open items

·         Highlights/reports client-specific risks and areas of opportunity

·         Implements and maintains employee-specific staff development plan

·         Optimizes organizational structure and work allocation to ensure adequate support exists across all clients to mitigate execution risks

·         Ensures quality control of all standard client deliverables (e.g. market-specific presentations) produced by Provider Ops team

·         Assesses client/provider escalation workload to determine appropriate staffing levels

·         Partners with Ops Data Analysts to develop actionable reports designed to identify trends in provider behavior

·         Monitors provider behavior reports and allocates resources to complete activities designed to address opportunities

·         Ensures team is properly trained and participates as needed with WebConsult webinars

·         Implements tracking system to properly assess timely completion of all assigned team tasks/activities

·         Participates as needed in prospect and client meetings to ensure appropriate engagement

·         Understands the products/programs/services provided by HealthHelp

·         Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs

·         Adheres to both URAC & NCQA standards pertinent to their job description

Qualifications

QUALIFICATIONS

·         5+ year of experience in managed care/ utilization management preferred

·         5+ year of experience with Medicare and Medicaid regulations preferred

·         Master's Degree in Business or Health Administration preferred or equivalent years of experience

·         Demonstrates strong leadership skills to facilitate cooperation and project management among cross-functional teams and clients

·         Excellent interpersonal and customer service skills, with the ability to communicate efficiently with individuals at all seniority or C-Suite levels

·         Strong analytical and critical thinking skills. Ability to obtain, manipulate, and interpret various reports and data to produce meaningful information

·         Reliable and trustworthy

·         Detail oriented and organized in approach

·         Proven project management, task management and execution management skills

·         Experience working in cross functional and matrixed management operating teams

Additional Information

All your information will be kept confidential according to EEO guidelines.