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VP, Network Management

Access Health Professional Employee Organization Little Rock, AR
  • Posted: over a month ago
  • Full-Time
  • Benefits: Vision, Medical, Life Insurance, 401k, Dental

Your Job Title: VP, Network Management Job #: 004

Reports To: CEO Department: Empower Healthcare

Pay Status: Salary Exempt Status: Exempt – Executive Benefit Classifications: Executive Team

Job Summary

The Vice President, Network Management (VP, NM), in concert with and under the direction of the Empower Chief Executive Officer (CEO) will be responsible for providing senior level leadership, guidance and oversight over all network management including: provider contracting, regional contracting, network strategic relationships, and provider relations management.

The position will develop, lead and align the execution of both short-term tactical initiatives and long-term strategies which will facilitate the organization’s ability to meet or exceed annual medical cost budgets. The VP, NM will provide oversight of major corporate-wide medical and provider-oriented projects/initiatives. In partnership with the Centralized Executive Administration team and the organization’s medical and pharmacy directors and strategic partners; the VP, NM will integrate provider network plans, activities, programs, policies and initiatives throughout the company to meet corporate objectives.

The VP, NM will exhibit insight, innovation and leadership to drive multiple strategies which will result in effectively managing medical benefit costs while continuously improving quality, access and customer satisfaction.

Essential Functions & Responsibilities

Directs and oversees activities associated with Provider Network Management, Provider Contracting and Provider

Support Services.

Essential Functions and Responsibilities

· In partnership with the Chief Executive Officer, leads the development and implementation of all provider network management strategies and programs.

· Leads the functions in provider network management and provider contracting.

· In partnership with the CFO, VP of Clinical Health Services Management (CHSM), medical and pharmacy directors, provides strong leadership in implementing initiatives and strategies to control medical costs to achieve budgeted medical cost targets. This should occur through support of state-of-the-art provider contracts which incorporate the principles of performance accountability, effective medical management strategies, use of health information technology systems and implementation of a process of continuous improvement in care and/or supported services delivery.

· Oversees the development and implementation of provider contracting strategies and provider contracting negotiations and ensures the terms of the contracts are fulfilled.

· Develops and implements a set of strategies to guide provider contracting and servicing activities for business expansion.

· Develops and implements strategies to strengthen and/or develop new physician, hospital and other provider relations. Defines provider network expansion requirements in new and existing geographic service areas.

· Incorporates new, innovative, emerging and/or effective quality and benefit cost control programs to improve the delivery of high quality and cost-effective care for the organization’s membership.

· In concert with developing collegial and mutually beneficial relationships, provides insight and information to Board of Managers relative to provider contracting activities.

· Ensures timely and comprehensive resolution of issues related to contracting and provider relations management.

· Develops, implements, and interprets departmental policies/procedures and communicates to other areas, as appropriate. Revises, updates, and changes policies as necessary.

· Communicates operational issues and changes related to strategic contracting activities to appropriate internal management.

· Reviews requests for contracts to determine appropriateness based on the company’s strategic plans, policy and procedures, and other established guidelines.

· Assists with development of a strategic plan for the area, in support of the corporate strategic plan.

· Develops long- and short-term goals and objectives for network management.

· Ensures objectives are consistent with strategic plans, corporate philosophies/mission, and follow established regulations, guidelines, and standards.

· Monitors and provides ongoing analyses of provider networks to ensure network and contract compliance.

· Works with Compliance and other areas to ensure contracts meet regulations/guidelines established by external organizations, including, but not limited, state and federal agencies, NCQA, and ODI.

· Makes changes to contracts as necessary to meet compliance and business requirements.

· Actively participates in negotiations and other aspects of contracting processes, to meet stated goals and objectives.

· Collaborates with Empower and delegated entities (Beacon, Evolent and Access Health) management teams on key objectives and system-wide programs. Effectively represents EHS’s interests and relationships with health systems, medical groups, ancillary and community-based provider of services to Empower members.

· In partnership with the Chief Financial Officer, reviews, revises and directs departmental budgets for assigned areas and develops a broad-based organizational budget strategy, incorporating both long and short-term corporate objectives.

· Participates in the development of cost management initiatives and programs to improve financial performance.

· Expertise with developing global pricing models, value-based pricing, capitation, and risk sharing contracting models.

· Familiar with Network develop modeling tools (heat mapping) to achieve network adequacy.

· Familiar with principles and development of Clinically Integrated Networks (CIN), Accountable Care Organizations (ACO) and other like provider-led network healthcare delivery models.

· Demonstrated or equivalent experience in leading all aspects of provider network activities, including network development, provider contracting strategies and negotiations, and provider servicing and relations which will facilitate the creation and maintenance of a high performing, accountable and engaged provider network.

· Strategic influencer who drives agreement through intellect, interpersonal and negotiation skills.

· Ensures interfaces exist with existing MSA-related partners and other strategic partners to ensure coordination and communication.

· Performs all job functions with integrity. Provides timely internal and external customer service in cooperative, professional, and respectful manner.

It is vital that an individual in this position be capable of good communication skills. It is of the utmost importance that written communication is legible.

Other Functions

As assigned by supervisor.

Supervisory Responsibility

Directs and supervises work of direct and indirect (via MSA – Beacon and/or Access Health) supporting managers

and staff; provides guidance on complex strategic issues.

· Supervises professionals and managers; provides guidance on complex strategic issues.

· Provides instruction to encourage fiscal responsibility to ensure compliance within departmental budget limits.

· Provides guidance to supervisors and managers in developing department budgets and maintaining fiscal responsibility.

· Directs and motivates departmental management team members to enhance personal and departmental performance.

· Conducts performance reviews. Documents and addresses performance issues in timely and positive manner.

· Proven ability to attract, build, mentor and direct a high-performing cohesive and well-integrated team.

· Understanding of the business environment and community, as well as trends and issues which will, or could potentially, influence the organization’s business performance.

Access to Protected Health Information
Minimal necessary to perform job functions

Complexity

Highly Complex: independent judgment, decision-making, problem solving relating to strategic planning and

technical systems that affect overall direction of company.

Stress

Very High: requires close concentration to workflow that is high and/or of considerable variety; frequent interruptions and distractions; involves developing, implementing, monitoring work that affects overall direction of company; consequence of error affects overall operations of company. Routinely required to calm and gain confidence of others.

MINIMUM JOB REQUIREMENTS

Educational Requirement

Minimum Bachelor’s degree in Business Administration, Healthcare Administration or related field with a relevant

advanced degree (MHA or MBA) preferred.

Skills and Specifications:

· Maintain current knowledge about issues affecting healthcare delivery system.

· Work effectively with Empower Board of Managers and Committees, and physician members.

· Excellent computer skills and ability to acquire skills to operate application packages.

· Organize and manage time to accurately complete tasks within designated time frames in multi-task, fast-paced environment.

· Maintain current knowledge of and comply with regulatory and company policies & procedures.

· Maintain confidentiality of member health and business information.

· At least 10 years of relevant health plan experience; with demonstrated competency in strategy development, negotiations, execution and implementation of contracts.

· Minimum five (5) years of relevant management experience.

· Demonstrated or equivalent experience in developing and managing networks to support comprehensive health insurance products.

· Demonstrated financial acumen and experience using medical cost and other data and information as the basis for making sound decisions in contracting, as well as in the delivery of medical management, quality management and related improvement programs.

· Experience working closely and effectively with physicians, hospitals, and other healthcare providers, with a preference for experience in integrated delivery systems.

· Proven leader with a demonstrated ability to lead and influence the direction of large-scale enterprises.

· A strong leader with proven ability to identify the need for change, anticipating, recognizing and creatively addressing resistance to change; working with others to view change as a challenge and opportunity for growth.

· Complete understanding of Medical Loss Ratio (MLR) cost drivers and a demonstrated success in managing the medical cost component of the MLR.

Required Experience

· 7+ years performing same or similar responsibilities in a provider-sponsored and/or not for profit health plan environment.

· Minimum 7 years direct supervisory experience also required.

Required Licenses and/or Certificates
NA

SKILLS AND ABILITIES

Communication

Highly Complex: ability to communicate highly complex information verbally and in written form that may include strategic policies, projects, and program processes, ability to negotiate and persuade internal managers/directors, external upper-level management professionals, and board members; ability to interface with upper management professionals and board members.

Analytical

Financial, Medical Informatics, Value and Evidence-based Reimbursement Model Development

Other Skills and Abilities

· Excellent computer skills and ability to acquire skills to operate application packages.

· Organize and manage time to accurately complete tasks within designated time frames in multi-task, fast-paced environment.

· Maintain current knowledge of, comply with regulatory and company policies & procedures.

· Flexible: ability to adjust work hours to meet business demands.

· Good organizational skills and attention to specifications are required.

· Able to remain productive under pressure as part of a professional team.

· Ability to read, write, analyze and interpret technical and non-technical reports in the English language.

· Demonstrate excellent, positive leadership, management and strategic skills.

· Make sound decisions and recommendations based on consideration of facts, priorities, resources, constraints, and alternatives.

· Organize and manage time to accurately complete tasks within designated time frames in fast paced environment.

· Maintain current knowledge of and comply with regulatory and company policies & procedures.

· Maintain confidentiality of patient and business information.

Physical Effort and Dexterity*

· Sit and/or stand for prolonged periods.

· Bend, stoop, and stretch.

· Lift up to 25 pounds.

Visual Acuity, Hearing, and Speaking*

* Candidates whose disabilities make them unable to meet these requirements will still be considered fully
qualified if they can perform essential functions of job with reasonable accommodation.

Scheduling

Frequent overtime work throughout year, with heavy overtime during peak periods. Frequent travel which may

require use of personal auto to attend meetings, conferences, workshops, and/or seminars.

Safety Hazards and Environment

Minimal hazards. General office working conditions.

Employer Rights

This job description does not list all duties of job. You may be asked by your supervisor, manager, or director to

perform other duties. You will be evaluated in part based upon performance of tasks listed herein.

Access Health Professional Employee Organization

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