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Director of Network Relations

Job Ref: 63586
Category: Professional
Department: NETWORK RELATIONS
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $205,000.00
Salary Range: $205,000.00 - $211,429.00

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

The Director of Network Relations has direct responsibility for all Network Relations related functions and duties for MetroPlusHealth. This includes all on-site clinical/utilization management services, customer service and relationship manager services rendered at the H+H facilities. The incumbent sets strategy for the Network Relations staffing assigned to the MetroPlus provider networks and is responsible for integrating the various components of the business operations to ensure operational/developmental goals are achieved.

Job Description

  • Develops and executes strategic initiatives and programs to enhance existing functions and develop new ones in support of corporate initiatives and requirements.
  • Directs and oversees the network assigned field staff of Relationship Managers and Network Service Representatives. Establishes administrative priorities and accomplishments for each network assigned staff and manages network assigned directors and/or managers.
  • Works closely with all MetroPlus departments and the CMO to coordinate the performance of all external MetroPlus staff and to oversee the quality of services delivered to our facility and community partners. Focuses on the financial performance of the MetroPlus-affiliated risk bearing entities, delivers management reporting and helps develop and implement action plans to help improve performance.
  • Monitors the analyses, projects, training/education and initiatives of the Relationship Managers.
  • Monitors the customer and clinical services rendered at the facilities as well as the work quality to assure conformity with corporate objectives and goals.
  • Manages the relationship between MetroPlus and top-level administrators at each assigned network facility (including senior facility executives and clinical level directors). Responsible for review of performance on key indicators (quality, utilization, financial, operational), negotiating improvement goals, assisting in the development (and in some cases in the implementation of) improvement plans, and routinely reviewing progress on those plans with facilities.
  • Oversee the Special Investigative unit to ensure the Plan is detecting and pursuing action against fraudulent activities. Establish standardizing reporting and ensure adherence to department goals.
  • Coordinates the relationships between facilities/sites in each network, coordinating events with the community/government agency offices within the network, etc.
  • Establishes plans of action, allocation of staffing resources, scheduling, etc., to ensure operational efficiency consistent with corporate and departmental goals.
  • Ensures adherence to all legislative and regulatory requirements.
  • Conducts special projects including business analyses, strategic planning, and implementation efforts on new business acquisitions and changing corporate requirements.
  • Coordinates and supervises operational analyses and implementation support on major workflow and activity modifications.
  • Implements changes for operational methods, procedures, policies and workflows affecting the assigned network staff.
  • Manages the overall budget in support of the responsibilities of the areas and corporate initiatives and responsibilities.

Minimum Qualifications

  • A Master’s Degree with a specialization in Hospital Administration, Health Care Administration, Administrative Medicine or in Public Health when conferred for a program in Hospital Administration from an accredited college or university; and,
  • Six years of high-level responsible experience in Hospital Administration, Business Administration, Public Administration or an equivalent field, or as an Assistant to a Hospital Administrator in a position of direct responsibility for operations of a major part or all of a hospital, including substantial exposure in meeting community health needs; or,
  • An equivalent combination of training, education and experience in related fields and educational disciplines.
  • Thorough knowledge of the fundamentals of hospital organization, administration and standards, regulations and laws applicable to hospital operations, knowledge of business and human resources administration principles, management functions, management processes and functions of hospital departments, and ability to direct and supervise personnel.

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical Skills
  • Written/Oral Communications