Job Summary:The Associate Vice President, Network and Contracting is responsible for the planning, execution, and strategic plan to build hospital, provider and ancillary provider contracting, service, and provider data integrity to facilitate optimal member access, successful business growth initiatives and sound plan financial performance.
Essential Functions:- Oversee Provider’s Contracting and Network operational strategy for assigned market, ensuring outcomes are measurable and aligned as part of a data informed strategy that ensures overall quality and compliance with State and Federal requirements.
- Develops and maintains a market-specific Provider Reimbursement Strategy consistent with Reimbursement Tolerance Parameters (across multiple specialties/geographies); Oversee the development of new reimbursement models and approval process for Health Plan exceptions for all lines of business.
- Establish and sustain relationships with regulatory agencies (e.g., Department of Medicaid, CMS, etc.) and other stakeholders to identify and create competitive advantages for CareSource.
- Manages strategic positioning for provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements.
- Oversee complex contracts and negotiations for fee for service and value-based reimbursements with hospitals and other providers.
- Collaborate with market and enterprise committees and workgroups to ensure alignment and overall implementation of assigned market strategy.
- Lead and develop a high‑performing contracting team, creating a culture of growth, collaboration, and accountability.
- Meet or exceed projected member access, product, utilization and budget requirements in all geographic regions pursued by the Plan, leveraging traditional, virtual and delegated partner providers.
- Collaborate with the market Executive team to ensure provider contracting and network performance related to CareSource enterprise and Market strategies, contractual, policy, and state/federal programs.
- Collaborate, innovate and support provider approaches to address contract compliance, industry supported contract requirements and financial alignment.
- Collaborate with Enterprise and Market leadership on the development of overall program strategy and business objectives with respect to Provider Contracting and Network.
- Develops and maintains Contract Negotiation tracking system, ensuring accurate and timely contract loading, submissions, and network implementation activities, and develops and delivers enterprise-wide training for contract management system
- Ensure budget and financial goals are set in conjunction with the Market executive team.
- Perform any other job related duties as requested.
Education and Experience:- Bachelor's degree in related field required
- Master's degree preferred
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Ten (10) years experience in health care external stakeholder and community program support, project and program management; complex business processes, strategic and business planning or related required
- Five (5) years of prior management experience required
Competencies, Knowledge and Skills:- Proficient in Microsoft Excel, Word, PowerPoint and Excel
- Critical listening and systematic thinking skills
- Planning, problem identification and resolution skills
- Business process/management skills
- Strong financial background
- Ability to maintain confidentiality and act in the company’s best interest
- Strong oral, written, and interpersonal communication skills
- Excellent leadership, management and supervisory skills and experience
- Energetic, enthusiastic, and politically astute
- Ability to act with diplomacy and sensitivity to cultural diversity
- Responsive to a changing environment
- Strategic deployment and management skills
- Conflict resolution skills
- Knowledge of regulatory reporting and compliance requirements
- Proficiency with provider engagement, performance improvement and operations
- Ability to work with multi-disciplinary departments across the organization
- Demonstrated ability to develop, prioritize and accomplish goals
- Strong interpersonal skills and high level of professionalism
- Ability to work independently and within a team environment
Licensure and Certification: - Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
- To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
- CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:- General office environment; may be required to sit or stand for extended periods of time
- Up to 50% (frequent) travel based on the needs of the department may be required
Compensation range $150,000-$300,000. CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Energize and Inspire the Organization
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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