Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Director, Network Strategy & Planning
Summary of Job
Summary of Job
Responsible for developing, managing, and executing Network-wide policies and standardized processes that impact the entire provider continuum including: network strategy and planning; performance monitoring; and integration activities within and outside the organization. Influence provider-related operations and processes at all organizational levels, including product, and operation. Oversee strategic and budgeting functions for the delivery system and optimal operating model. Build trust and establish stakeholder relationships focused on open communication with Enterprise and external leaders.
Responsibilities
• Oversee the assessment, development, and implementation of enterprise policies, including controls that drive processes across the provider continuum to ensure standardized, financially transparent processes.
• Serve as Project manager for the enterprise-wide multi-year initiatives
• Oversee strategic and budgeting functions. Optimize cross-departmental functions and operations.
• Drive a standard process to enhance optimization, and standardization of provider-related activities.
• Conduct research, solution development, financial modeling, implementation management, reporting, training, and communications.
• Drive a standardized approach to provider contract negotiations with controlled, consistent exception processes.
• Support an enhanced operating model, serving as a recognized change agent for the enterprise by influencing acceptance of change and defining an appropriate implementation plan.
• Provide leadership with support and direction in resolving escalated, cross-functional issues impacting providers and supporting functions.
• Inform and support the development and implementation of best practices across the provider continuum to ensure coordination for optimal outcomes and reduce redundancy.
• Create and influence opportunities to enhance the organization’s agility and scalability for growth and change.
• Provide guidance and direction to other functional leaders within the Network and act on behalf of the Network SVP within the Network department and externally to other corporate departments.
• Collaborate and influence internal and external stakeholders across all organizational areas, including Business Development, Contracting, Provider Performance, Pricing, Actuary, Communications, Training, Human Resources, Government Relations, IT, Legal, Regulatory, Compliance, and Products.
• Assess and redefine provider satisfaction and demonstrable avenues to materially impact results.
Qualifications
• Bachelor’s degree (Required); Master’s degree (Preferred)
• Project Management (PMI) certification (Preferred)
• 10 – 12+ years of relevant, professional work experience (Required)
• Working knowledge of healthcare regulatory requirements/environment (Required)
• Proven track record of project management with large (department/divisional/enterprise) projects, from strategizing to implementation (Required)
• Ability to identify and discern indicators of success for network strategy implementation(s) (Required)
• Staff and process management experience (Required)
• Ability to establish, maintain, and enhance relationships (Required)
• A deep understanding of managed care, network contracting, and operations and their impacts across the enterprise, and external stakeholders (Required)
• Strong communication skills (verbal, written, interpersonal, presentation) will all types/levels of audiences (Required)
• Proficient with MS Office – Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.