Director- Medical Network Management

GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.

An Executive Order was released stating that federal contractors must require COVID-19 vaccinations for all US employees. As a company that works on federal contracts, we have a legal requirement to comply with the executive order, if it is enforced.

Please note that the salary information is a general guideline only. GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate's work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.

Primary responsibilities:

• You will have oversight of GEHA's leased provider networks and ancillary network partnerships: GEHA contracts with external partners to provide our members with access to medical networks, telemedicine, and cost transparency, among others. You will be responsible for ensuring contract compliance, monitoring performance guarantees, and analyzing financial performance to ensure that we are achieving expected savings. You will also be focused on continual process and program improvement by evaluating current programs, identifying new opportunities for additional savings, continually monitoring program results.
• You will be the business leader for key projects related to our network and ancillary partner strategy: Working with the GEHA Vendor Management Office during the provider network RFI & RFP processes including assisting in the development of RFP questions, analysis and scoring of responses, and partnership selection.
• You will be an escalation point for network-related items, partnership with internal audit, SIU, appeals, and claims operations to handle escalated provider and/or member issues.
• Excellent People Management: This team is composed of approximately 25 individuals, four of which will report directly to you. You person will be responsible for maintaining high morale, engagement, and operational excellence.
• You will be taking operational, financial, and other data elements to make strategic decisions related to our short and long-term strategy. You will distill complex, analytical information in presentation-friendly formats including graphical displays to a wide variety of audiences. You will translate strategy into defined tactics, programs/projects, priorities, and timelines.
• You will have responsibility to manage department budgets, goals, and will serve as a business lead and liaison for major projects and initiatives.
• And other duties, as assigned.

Qualifications:

• Bachelor's degree in a business-related field or commensurate experience.
• Combination of education/experience which provides equivalent background will be considered
• 10 + years of related experience to managed care, strategy, and/or consulting
• Five (5) years of people leadership experience
• Strong communication skills, ability to communicate effectively with senior management.
• Strong analytic skills, the ability to use data to derive strategy
• Proficiency with MS Word, Excel, and PowerPoint
• Demonstrated leadership skills, ability to coach, mentor, and foster a culture of continuous learning.
• Experience and demonstrated success in managing and motivating a large, diverse staff and the ability to effectively resolve problems in partnership with other departments and at all management levels.

Preferred Qualifications:

• Working knowledge of managed care, health insurance, and/or provider networks

GEHA is an Equal Opportunity Employer. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470 with a total of five locations in the Kansas City metropolitan area.