Sr. Director, Provider Network Operations

Reporting to the COO, the Senior Director, Provider Network Operations provides strategic leadership and oversight for network management, provider contracting, provider operations and provider relations. You will develop and implement network strategies, manage provider contracts and negotiations, monitor provider performance metrics, and collaborate with key stakeholders to drive network growth and performance, and maintain provider relationships. You will manage a team of successful PNO professionals.

Please note that while SFHP supports a hybrid work environment, this role will be required to be onsite and in-office a minimum of 4 days per month. This position is based in our Downtown San Francisco office.

Salary: $205,000 to $230,000 per year

WHAT YOU WILL DO:

• Develop comprehensive network strategy aligned with organizational growth and performance goals
• Manage a high-value provider network by evaluating potential network providers, negotiating contracts, and establishing relationships with healthcare providers to ensure a comprehensive and high-quality network.
• Optimize the network's performance by analyzing network data, utilization patterns, and market trends to identify opportunities for network enhancements, cost savings, and improved access to care.
• Develop a comprehensive provider performance program with standardized performance reporting, provider engagement process, provider improvement initiatives and escalation activities for patterns of non-performance.
• Oversee key network contracting activities, including fee schedules negotiations, reimbursement and capitation rates, and contract terms and conditions.
• Develop and deploy a comprehensive provider communication and training program, designed to improve provider performance and satisfaction.
• Oversee provider relations and issue resolution activities
• Oversee provider operations, including credentialing and recredentialing, provider data management and provider directories
• Conduct market analysis, assess competitive landscapes, and make recommendations for network expansion strategies.
• Lead a diverse departmental staff to build and retain a qualified team.

WHAT YOU WILL BRING:

• 10+ years' experience in a leadership role in a health plan or complex provider system overseeing provider and network performance programs
• Expert level experience contracts negotiation with complex provider systems.
• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements.

WHAT WE OFFER:

• Health Benefits
  
  
  
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
  
  
  
  
• Retirement - Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off - 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

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