Description

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veteran, Military Spouse or Military Affiliated are encouraged to apply!

Job Summary

The Vice President of Provider Network Operations is responsible for planning, organizing, and directing network operations to ensure the effective growth and maintenance of the provider network, meeting contractual obligations, and achieving VA/DoD network adequacy requirements. These responsibilities include major strategic control over short and long-term planning, operational excellence, and building strong relationships with TriWest, shareholders, business partners, network subcontractors, and VA/DoD providers.

Education & Experience

Required:

• Master's Degree in Business, Health Care Administration, or related field or equivalent work experience
• 10+ years of diverse health care administration experience
• 5+ years of experience in Managed Care Operations
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• Strong health care data management experience to include provider data and associated systems
• 5 years of experience managing provider network credentialing programs, provider data, provider contracting, and sub-contractor management

Preferred:

• Experience in government programs (e.g. TRICARE, Veteran Affairs, Medicare, Medicaid)

Key Responsibilities

• Oversee all fully delegated networks to ensure network adequacy requirements are consistently achieved.
• Oversee all credentialing processes in compliance with URAC industry standards/regulations as well as requirements prescribed per TriWest program contracts.
• Oversee program management of all provider network focused systems.
• Ensure the accuracy of all data in provider directory across all geographic areas and specialties.
• Lead efforts to operationalize provider data management systems.
• Analyze and report on the impact of change orders, control letters and other directives with implications for TriWest departments.
• Lead efforts to drive continuous provider satisfaction and provider relations.
• Oversee the development for primary source credentialing that meets defined standards.
• Conduct research, identify problem areas, and report on the VA/DoD network, and associated issues to TriWest senior leadership.
• Prepare for and meet all URAC standards for VA/DoD Health Networks.
• Analyze, develop, and implement continuous quality improvement process for Provider Network Management. • Directly interface with shareholders and VA/DoD providers on credentialing and provider data issues.
• Develop and maintain production standards in Network Compliance department ensuring quality control and timely and accurate management of provider files, credentialing and contract maintenance.
• Monitor and manage VA/DoD network discounts levels.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, Excel, PowerPoint, TriWest Intranet, the Internet, and department software applications.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Technical Skills: Knowledge of budgeting process and staff planning concepts.

Working Conditions

Working Conditions:

• Works in a hybrid environment both at home and in the office with frequent travel
• Department of Defense security clearance

Company Overview

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!

Our job is to make sure that America's heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $280,000 to $296,000 per year.

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.