Director, Network Development and Contracting
Overview Oversees the development and implementation of VNSNY CHOICES's provider network which includes contracting, rate setting, monitoring for and maintaining network adequacy of all Physician, Ancillary and Hospital 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. Responsibilities Collaborates with CHOICE 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 CHOICE's 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 all provider network contracting, including negotiation of contracts done by internal staff and outside consultants for service area 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. Oversees the development and maintenance of all provider contract templates for all lines of business. 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 CHOICE departments and updates provider materials accordingly. Works with Quality and Medical Management Department to ensure quality assurance monitoring of network providers. Keeps abreast of current industry trends, governing regulations, reimbursement practices and market players. Keeps CHOICE management informed of trends/changes and makes recommendations based on this information. Performs all duties inherent in a senior management role. Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes and terminates staff and recommends salary actions as appropriate. Maintains visibility in the provider community by attending provider-sponsored events, seminars and conferences. Participates in special projects and performs other related duties as assigned.
Qualifications Education:
Bachelor's Degree in Business, Health Administration, Health Policy or equivalent work experience required.
Experience:
Minimum ten years' experience in health care, with a minimum eight years in managed care provider contracting and a minimum of four years in provider relations or contracting leadership capacity required. Experience working with network service providers and negotiating/administering contracts required.
Salary Range:
$200K -- $250K
Minimum Qualification
Healthcare ManagementEstimated Salary: $20 to $28 per hour based on qualifications.
Qualifications Education:
Bachelor's Degree in Business, Health Administration, Health Policy or equivalent work experience required.
Experience:
Minimum ten years' experience in health care, with a minimum eight years in managed care provider contracting and a minimum of four years in provider relations or contracting leadership capacity required. Experience working with network service providers and negotiating/administering contracts required.
Salary Range:
$200K -- $250K
Minimum Qualification
Healthcare ManagementEstimated Salary: $20 to $28 per hour based on qualifications.
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