Canopy Health is a community of caregivers championing health. Owned by physicians and hospitals, our focus is on improving health, advocating for the entire Bay Area, and supporting individuals in a way that is empathetic and respectful. Our large and growing network of physicians and other providers offers consistently high-quality care with clear, foreseeable costs. Now is your chance to apply your passion to our mission. We are hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. You would execute the day-to-day strategy of our provider contracting efforts.

The primary focus of the Director of Network Development position is to assist in health plan negotiations and lead hospital, physician group, and ancillary contracting efforts. This position is responsible for ensuring all contract requirements are met, maintained, and communicated appropriately to all appropriate internal and external staff. The Director will ensure strong and effective relationships with health plans, hospitals, medical group, and ancillary providers. In addition to contract negotiations, the Director will provide support to the Chief Network Development Officer with regard to claims review to ensure payments being made by Canopy Health are correct per each agreement. Additional areas of focus will include: developing an approach with the existing-third party vendor to ensure all ancillary provider contracts are loaded appropriately and credential all appropriate ancillary providers, work with partner health plans and medical groups to ensure appropriate network adequacy for both the DMHC and CMS and provide contract analysis and detailed review when asked internally. 

PRINCIPAL ACCOUNTABILITIES

• Work closely with the Chief Network Development Officer in developing and maintaining strong contractual and collaborative relationships with provider partners for HMO and Medicare Advantage products
• Develop and manage all contracting efforts and partnerships to achieve quality, cost management, and strategic business development objectives
• Responsible for effectively negotiating complex contractual agreements, including incentive programs, to support Canopy Health strategies in current and expansion markets. Responsible for annual review of contracting strategy each year, which includes establishing a detailed plan for each major contracting entity
• Lead negotiations for key contracts and assures all contracting strategies are being executed timely and appropriately.
• Manage contract performance and support the development and implementation of value based contracting initiatives in support of Canopy Health business strategies. Partner with Chief Network Development Officer to determine network and contract requirements
• Monitor local market trends relative to contracting, make recommendations to modify current process, and lead or assist in implementing change as necessary
• Responsible for TPA's system being properly notified and updated with accurate implementation of complex contracts with hospitals and other key providers
• Develop and maintain process, systems and measures that ensure timely and accurate execution of contracting objectives
• Utilize creative and innovative approaches to introducing new processes or evaluating existing activities
• Responsible for on-going communications with CEO and COO about key developments, updates, and goals of the negotiation process.
• Responsible for understanding, managing, and executing on medical cost initiatives
• Work using a proactive, collaborative effort with other internal departments on resolution of complex issues and provider complaints on payment issues
• Work with the Canopy TPA to ensure contract loading and ancillary credentialing process is completed in an appropriate and efficient manner
• Ensure Canopy Health Network meets all necessary network adequacy requirements sent by state and federal entities
• Recruit providers as necessary to ensure the network expansion efforts and adequacy requirements
• Focus on developing consistent, operationally supportable contracts to enhance efficiency
• Manage provider reimbursement activities in collaboration with other Canopy Health staff
• Any other duties as required to ensure Canopy Health operations are successful. Ensure the privacy and security of PHI (Protected Health Information) as outlined in Canopy Health's policies and procedures relating to HIPAA compliance