Job Description

HealthPartners is hiring a Network Management Electronic Commerce Director. This role provides leadership, oversight, optimization and direction for strategies, functions and operations of provider electronic commerce, provider data support and provider regulatory compliance. They will lead the development and successful implementation of key provider projects and strategic operational initiatives. This role work and collaborate with multiple departments and all levels of staff within the organization.

ACCOUNTABILITIES

1. Responsible for senior management leadership and the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees for Provider Contracted Care Compliance, Provider E-Commerce and Provider Data Support functional areas with the department.
2. Ensure compliance with federal and state regulations & organizational and departmental & division policies and procedures. Conduct necessary audits, reporting and monitoring of operations, systems and functional areas in support of regulations and internal audits.
3. Facilitate governmental and regulatory compliance on behalf of the Network Management Division (HHS, CMS, MDH, DHS, NCQA etc.)
4. Analyze and interpret impact of federal and state legislation and regulatory provisions in HealthPartners products/networks, as they relate to the organization and operations.
5. Manage complex projects, charter submission, funding request and project budget. Lead multi-departmental and multi-organizational teams to implement provider data support, network management, electronic commerce, and provider compliance’s initiatives at HealthPartners. This includes coordinating the activities of multiple areas within HealthPartners and external to HealthPartners for projects with clearinghouses, vendors, and other partners.
6. Develop and sustain highly collaborative relationships with multiple internal and external customers and colleagues to ensure successful implementation of electronic commerce, and other key network management initiatives. Identify and initiate opportunities for HealthPartners to collaborate in new ventures or partnership opportunities.
7. Facilitate communication and marketing strategy with providers, business functional leaders, IS & T, staff, senior leaders regarding applications, operational & functional area development, including impact analysis of new business initiatives, regulatory changes and strategic projects.
8. Develop and promote electronic commerce with providers and partners to ensure collaborative goals with Claims, Network Management and the organization are met and/or exceeded.
9. Represent HealthPartners in external organizations, such as MN Administrative Uniformity Committee (MN AUC) to provide expertise and influence in state and federal discussions & legislation regarding electronic commerce, provider compliance, provider data and network management issues. Coordinate activities with collaborating internal departments and communicate with HealthPartners senior management, keeping them informed of issues and developments. Maintain up-to-date knowledge of network management and electronic commerce issues at the state and national level.
10. Lead strategy development and planning for electronic commerce, provider compliance and provider data support and other key network management initiatives and objectives. Work cooperatively and effectively with multiple business and technical areas within the organization to determine the approach that best addresses the overall organization’s strategic requirements, as well as the community initiatives and issues.
11. Incorporate tools and philosophy of continuous quality improvement and optimization into daily work and projects.
12. Identify, manage and resolve critical issues.
13. Anticipate resource needs and set priorities, obtain financial and staffing resources in support of departmental goals and expected deliverables.
14. Develop, negotiate and oversee compliance of clearinghouses, vendors, and others partner contracts whose partnership and services are critical to the success of HealthPartners network management and electronic commerce functions.
15. Participate and monitor annual budget, departmental goals/objectives, long-range strategic planning.
16. Participate in cross-functional strategy design and operation teams in corporate initiatives.
17. Develop and maintain a broad base knowledge of the health industry, as well as HealthPartners’ provider, network, operational, administrative, technical and system functions.
18. Actively participate in the creation, updates and ongoing testing of business continuity and disaster recovery plans.
19. Perform other duties as required.

REQUIRED QUALIFICATIONS

1. Four-year bachelor degree in health care, business, public administration, project management or related field.
2. Seven to ten years’ experience in the health care industry, health-related project management, health plan operations, or provider network management with five years working in management role.
3. Excellent leadership skills with a high level of interpersonal effectiveness.
4. Excellent oral and written communication skills with ability to make effective group presentations.
5. Excellent project management skills.
6. Previous leadership experience, independently responsible for the planning and development of a key company function.
7. Ability to work effectively with staff from multiple HealthPartners departments and levels as well as multiple organizations.
8. Proven technical skills. Ability to manage complex technical projects and strategies.
9. Ability to interact effectively with senior level health plan, government/regulator, provider and other community and national leaders.
10. Experience as negotiator; strong negotiating skills and ability to establish and maintain win/win relationships.
11. Knowledge of the philosophy and tools of continuous quality improvement and optimization and a willingness to use in both daily work and projects.
12. Ability to work and make logical decisions independently to accomplish organizational goals within the scope of the position as it relates to the annual and long-term goals for HealthPartners.
13. Work within the scope of budget priorities set by Sr. Vice President of Provider Partnerships for the Provider Network Management division or discuss deviations from budget.
14. Have broad latitude in the direction and influence for the use of resources to achieve key department goals and objectives. This position will operate with a high degree of independence in the execution of the functions and responsibilities.
    
    

PREFERRED QUALIFICATIONS:

1. Master’s degree in health care management, health care, business, public administration or related field.
   

DECISION-MAKING

1. The Director would be empowered to make decisions relating to and within the scope of the position as it relates to the annual and long-range goals for HealthPartners. Purchasing authority is $50,000.
2. The Director would work with the Electronic Commerce steering Committee to review and formulate strategies and approaches.
3. The Director would consult with the Vice President Network Management & Provider Relations on strategies and deviations from budget.