Provider Network Adequacy Analyst Jobs (NOW HIRING)

Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to some of the state’s most vulnerable and underserved residents.

Founded in 1999, we’ve grown from a single primary care office into a network of 50+ locations offering urgent care, primary care and specialty services, from women’s health to endocrinology and psychiatry. We also provide nursing home support, care management, and in-home care through our Essen House Calls program. Guided by a Population Health model, our team of 500+ providers deliver care in-person, at home, or via telehealth, ensuring patients get the support they need when and where they need it.

We’re looking for talented, motivated individuals to join our growing team. Whether you’re a medical provider, administrator, or operations professional, there’s a career here for you. Join us in making a real difference in the health of our community.

Job Summary

Position Title: Vice President of Contracting and Network Strategy

Reports to: Chief Financial Officer

Job Summary: We are seeking a Vice President of Contracting and Network Strategy for a provider group would lead the development and implementation of provider network strategies, including contracting, network expansion, and provider relationships. This role involves negotiating contracts, managing Health Plan relationships, ensuring network adequacy, and aligning contracting strategies with the organization's goals. The VP holds a critical leadership role focused on building and maintaining strong provider networks, optimizing payer relationships, and aligning strategy with value-based care. 

Responsibilities

Develop and execute provider network strategies:

• This includes planning for network expansion, evaluating network adequacy, and developing strategies to address specific needs or challenges.
• Develop and execute strategies that support the organization’s outpatient growth, cost-efficiency, and care delivery goals.
• Align contracting and network strategy with broader organizational priorities such as value-based care, health equity, and risk-based payment models.

Negotiate and manage provider contracts:

• Negotiate contracts with various types of providers (hospitals, physician groups, etc.), ensuring favorable terms and compliance with regulations.
• Manage and renew existing contracts, focusing on reimbursement models that support outpatient care, quality outcomes, and population health.
• Ensure compliance with federal and state regulations affecting contracts,

Manage provider relationships:

• Establish and maintain strong relationships with providers, addressing concerns and ensuring their satisfaction with the network.
• Build, expand, and maintain a high-performing outpatient provider network.

Ensure network adequacy:

• Analyze the network to ensure it meets the needs of members and aligns with regulatory requirements.
• Analyze market trends, competitor networks, utilization data, and reimbursement patterns to inform strategy.
• Use data-driven insights to improve provider performance and patient access.

Develop and implement value-based payment strategies:

• Work with providers to develop and implement value-based payment models that align with the organization's goals.

Oversee the contracting process:

• Manage the entire contracting process, from outreach and recruitment to contract initiation, amendment, and termination.

Coordinate with related departments:

• Work collaboratively with credentialing, provider data management, and other relevant departments to ensure smooth operations.

Stay abreast of industry trends and regulatory changes:

• Keep informed about current trends in contracting and network management to ensure the organization remains competitive and compliant.

Qualifications 

• Master's degree or equivalent experience in healthcare administration, business administration, or a related field
• Strong knowledge of Provider Relations policies and procedures
• 8+ years of experience in the healthcare or managed care industry.
• Strong negotiaion and communication skills
• Knowledge of healthcare regulations and compliance requirements
• Understanding of value-based payment models
• Ability to analyze data and make informed decisions
• Required to lead and manage a team of contracting professionals and other related staff.
• Ability to function effectively within an ever-changing environment to meet deadlines and reprioritize as necessary
• Work requires a professional level of knowledge in health care administration, finance and clinical operations

Salary: $200,000-$250,000

Equal Opportunity Employer

Essen Health Care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.