Overview Oversees the development and implementation of VNS Health's Health Plan Physician, Ancillary, Hospital provider networks. Includes contracting, rate setting, monitoring for and maintaining network adequacy of all providers, the development of incentives, processes, policies, procedures and performance to ensure alignment and support of the company's product offerings and medical cost ratio (MCR). This includes the development and execution of plans for expansion of provider network opportunities as well as maintaining existing networks. Works under general supervision.
Compensation: $137,800.00 - $183,800.00 Annual
What We Provide
Referral bonus opportunitiesGenerous paid time off (PTO), starting at 30 days of paid time off and 9 company holidaysHealth insurance plan for you and your loved ones, Medical, Dental, Vision, Life DisabilityEmployer-matched retirement saving fundsPersonal and financial wellness programsPre-tax flexible spending accounts (FSAs) for healthcare and dependent careGenerous tuition reimbursement for qualifying degreesOpportunities for professional growth and career advancementInternal mobility, generous tuition reimbursement, CEU credits, and advancement opportunitiesWhat You Will Do
• Develops and oversees execution of provider recruitment strategies based on product line requirements, provider specialty, member benefit, network adequacy and market development input. Manages the recruitment process to identify and establish relationships with various service providers.
• Develops and negotiates contractual relationships with providers and foster wholesale marketing channels and innovative medical management strategies.
• Collaborates with Health Plans leadership to identify network and provider management opportunities that support achievement of increased quality and efficiency, including Value Based Payment contracting. Identifies and recommends best practices for operational improvements and performance for Health Plans products networks.
• Assesses network requirements as defined by the strategic direction of senior leadership and ensures that the contracted networks meet regulatory requirements established by CMS and NYS DOH. Regularly monitors and analyzes network adequacy, member demands, provider performance, market trends and other information. Develops and implements strategies to meet network capacity and regulatory requirements.
• Provides leadership and oversight for assigned provider network contracting, including negotiation of contracts done by internal staff and outside consultants for service area, product expansions and other projects.
• Develops and negotiates risk-based contractual relationships with Independent Physician Associations ("IPA"), group practices and individual physicians to foster wholesale marketing channels and innovative medical management strategies.
• Develops and oversees execution of provider recruitment strategies based on product line requirements, network adequacy and market development input. Manages the recruitment process to identify and establish relationships with various service providers.
• Identifies common issues affecting provider networks; works with staff and health plan colleagues in developing solutions.
• Establishes provider policies and procedures in collaboration with other Health Plans departments and updates provider materials accordingly.
• Works with Quality, Care Management and Utilization Management Department to ensure quality assurance monitoring of network providers.
Qualifications Education:
Bachelor's Degree Business, Health Administration, Health Policy or equivalent work experience required
Work Experience:
Minimum ten years' experience in health care, with a minimum eight years in managed care provider contracting and a minimum of two years in provider relations/ Behavioral Health. required
Experience working with network service providers and negotiating/administering contracts required
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