Vice President Provider Network Management Jobs in Riverside, CA

SENIOR VICE PRESIDENT, HEALTH PLAN GROWTH & STRATEGY

Company: BLEHEALTH, LLC
Department: Executive Leadership / Growth & Strategy
Reports To: Chief Executive Officer
Employment Type: Full-Time, Executive Leadership

POSITION SUMMARY

BLEHEALTH is seeking an accomplished Senior Vice President of Health Plan Growth & Strategy to lead the organization's health plan growth, payer contracting strategy, strategic partnerships, market expansion, and long-term business development initiatives.

This executive will be responsible for expanding BLEHEALTH's relationships with Medicaid managed care organizations, Medicare Advantage organizations, health systems, provider organizations, government agencies, and other healthcare partners.

The SVP will initially focus on maximizing BLEHEALTH's presence throughout California while developing and executing a disciplined strategy for expansion into additional states, and countries.

The ideal candidate will have significant experience within a Medicaid managed care organization, Medicare Advantage plan, population health organization, or comparable healthcare organization and will understand how health plans evaluate, contract with, implement, and monitor external provider and service organizations.

This is a growth and revenue leadership position. Success will be measured by new contracts, expansion of existing contracts, new markets entered, strategic partnerships developed, and revenue generated.

KEY RESPONSIBILITIES

A.    Develop and execute BLEHEALTH's comprehensive health plan growth strategy.

Identify and pursue new contracting opportunities with:

• Medi-Cal managed care plans

• Medicaid managed care organizations nationally

• Medicare Advantage organizations

• Health systems

• Physician organizations

• Accountable care organizations

• Government healthcare programs

• Other healthcare organizations

Build relationships with senior executives and decision-makers within targeted organizations.

Establish BLEHEALTH as a preferred partner for population health, care management, community-based services, and high-risk member engagement.

B.     Develop executive-level relationships with:

• Health plan CEOs

• Chief Medical Officers

• Chief Operating Officers

• Medicaid Presidents

• Network executives

• Population health executives

• Care management executives

• Community health executives

• Provider network leadership

• Contracting executives

Represent BLEHEALTH at executive meetings, conferences, industry events, and strategic partnership discussions.

Maintain ongoing relationships rather than limiting contact to contract negotiations.

C.     Develop a formal healthcare business-development pipeline.

Identify opportunities before formal RFPs are released whenever possible.

Maintain accurate pipeline forecasting and provide regular reports to the CEO.

D.    Lead the business strategy surrounding health plan contract negotiations.

Work collaboratively with legal counsel, finance, compliance, operations, and clinical leadership.

Evaluate:

• Reimbursement

• Payment models

• Performance requirements

• Service expectations

• Quality requirements

• Geographic scope

• Member volume

• Reporting requirements

• Financial risk

• Value-based payment opportunities

The SVP is not expected to replace legal counsel but should understand healthcare contracting sufficiently to lead commercial negotiations.

REQUIRED QUALIFICATIONS

• Bachelor's degree required.

• Advanced degree in healthcare administration, business, public health, or related discipline preferred.

• Approximately 10+ years of progressive healthcare leadership, managed-care, payer, population-health, business-development, or contracting experience.

• Demonstrated experience working with Medicaid managed care organizations.

• Strong understanding of healthcare payer-provider relationships.

• Experience developing or negotiating healthcare contracts.

• Demonstrated record of generating new healthcare business.

• Strong executive communication and presentation skills.

• Ability to communicate effectively with health-plan executives.

• Experience developing strategic partnerships.

• Strong understanding of healthcare reimbursement and managed-care economics.

• Ability to analyze new healthcare markets.

• Willingness to travel for health-plan meetings, conferences, and market-development activities.

STRONGLY PREFERRED EXPERIENCE

Ideal previous employers may include national or regional:

• Medicaid managed care organizations

• Medicare Advantage organizations

• Integrated health systems

• Population health organizations

Particularly valuable experience includes previous responsibility for:

• Medicaid

• Provider networks

• Population health

• Care management

• Network development

• Contracting

• Government programs

• Value-based care

IDEAL CANDIDATE PROFILE

The ideal candidate is not simply a salesperson.

BLEHEALTH needs an executive who understands:

Healthcare + Medicaid + Health Plans + Relationships + Contracting + Strategy + Revenue

The individual should be capable of walking into a meeting with a Medicaid health plan president or senior executive and credibly discussing:

• Population health

• Member outcomes

• Medicaid strategy

• Care management

• Network needs

• Reimbursement

• Quality

• Cost reduction

• Community services

• Value-based care

The candidate should have an established healthcare network and be capable of opening doors that BLEHEALTH would otherwise take years to access.

LEADERSHIP CHARACTERISTICS

The successful candidate should demonstrate:

• Executive presence

• Strategic thinking

• Accountability

• Strong relationship-building skills

• Negotiation ability

• Financial understanding

• Healthcare industry knowledge

• Initiative

• Integrity

• Results orientation

• Entrepreneurial thinking

This executive must be comfortable operating in a growing organization where building new systems and opportunities is part of the position.

COMPENSATION STRUCTURE

$140K + significant performance compensation

CRITICAL HIRING REQUIREMENT

The strongest candidate should be able to demonstrate:

• Which health plans they have worked with.

• Which executives they already know.

• Which contracts they have personally helped secure.

• How much revenue they have generated.

• Their experience with Medicaid managed care.

• Their experience expanding healthcare services into new markets.

• Their understanding of payer contracting.