Job Summary:
The VP, Network Strategy & Contracting is responsible for creating and executing the Market Network strategic plan including leading the market with Value Based Purchasing initiatives that differentiate and enable the market to excel, including Pharmacy, Retail and Behavioral Health initiatives.
Essential Functions:
- Create and execute the Market Network strategic plan including leading the market with Value Based Purchasing initiatives that differentiate and enable the market to excel, including Pharmacy, Retail and Behavioral Health initiatives
- Lead and influence stakeholders including the Department of Medicaid, Legislators, health partners and other stakeholders to create competitive advantages for CareSource and to fully understand the macro models being established or considered in the market and nationally
- Meet and exceed projected member access, product, utilization and budget requirements in all geographic regions pursued by the Plan, leveraging traditional, virtual and delegated partner providers
- Assure that the network(s) meet applicable standards of all Plan products
- Design & implement recruitment plans and directly negotiate and coordinate contractual, operational and service requirements for hospitals, physicians and ancillary providers
- Aggressively seek opportunities to improve the departmental work flows and increase efficiencies
- Promote positive relationships with the multitude of network providers
- Complete provider surveys periodically to identify opportunities for Plan improvement
- Consult with applicable regulatory entities and legal counsel as necessary to address, resolve or clarify contractual issues.
- Assure contracts meet all regulatory standards
- Comply with the Model Audit Rules (MAR) standards
- Ensure the creation and maintenance of policies and procedures as they relate to the management of the department
- Ensure compliance with departmental & corporate performance metrics
- Maintain a thorough understanding of all provider contract language -- identify and coordinate needed revisions.
- Maintain integrity of provider data including multiple enterprise and State systems as well as written documentation of provider network.
- Ensure timely on-boarding, including credentialing activities that are compliant with State and accrediting body requirements.
- Comply with all accreditation standards of URAC and the National Committee for Quality Assurance (NCQA).
- Lead/manage staff, including recruitment and selection, development and strategic and tactical management including excelling at employee engagement
- Prepare/meet annual budget to support business plans.
- Prepare performance, statistical, and other operational reports.
- Perform any other job related instructions as requested
Education and Experience:
- Bachelors’ degree in a business-related field or equivalent experience is required, Masters’ Degree is preferred
- Minimum of seven (7) years in of experience in the health care field is required
- A minimum of five (5) years of Senior Leadership experience is required
- Strong background and experience in all aspects of health care, including marketing, network development, finance and state regulatory guidelines is required
- Multi-state provider contracting experience is preferred
Competencies, Knowledge and Skills:
- Strategic and forward thinking; ability to lead within a matrix organization
- Proven ability to negotiate with and develop strong relationships with hospitals and providers
- Ability to manage a large, diverse staff
- Strong leadership and management skills
- Excellent communication skills
- Proven People management skills
- Ability to work independently and within a team environment
- Excellent Attention to detail and follow through
- Expertise within healthcare field
- Critical listening and thinking skills
- Training/teaching skills
- Customer service oriented
- Decision making/problem solving skills
- Collaboration skills
- Microsoft Word, PowerPoint and Excel Proficiency
Licensure and Certification:
- 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
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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