VP Network Development
Job ID 2013-22301 # Positions 1
Location US-NATIONWIDE
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 3/17/2013
Additional Locations ..
More information about this job:
Summary:
Ensures all aspects necessary to develop, maintain, and improve provider networks are met consistently to support the achievement of company goals. Functions include, but are not limited to, the identification, targeting, recruiting, contracting, and re-contracting with all types of providers including primary care physicians, specialist, hospitals, and allied services providers. Oversees strategic aspects concerning provider networks providing advice and guidance to the Health Plans. Responsible for maintaining compliance to company standards for areas influencing the management of provider networks. Provides leadership and development to team members within Network Development area.
Responsibilities:
1. Develops and recommends market specific provider network strategy to leverage opportunities and ensure achievement of organizational objectives.
2. Supervises the network development physician recruitment process and collaborates with multiple resources to convey opportunity and project a well-coordinated team.
3. Works collaboratively with the Plan and other cross functional areas to evaluate, recruit and contract with hospitals and organized provider groups.
4. Works collaboratively with finance in setting reimbursement guidelines including market specific models.
5. Creates continuity among all health plans in the areas of provider reimbursement, contracting, standards, and physician performance.
6. Negotiate provider contract language and reimbursement as needed.
7. Establishes standards, programs and process for provider network management, balancing best practices with knowledge of local market factors and needs to ensure success in all markets.
8. Works collaboratively with Business Development on new market development and entry.
9. Manages relationships with ancillary providers and ancillary vendors, and communicates contractual issues with appropriate enterprise departments.
10. Hires and develops staff, and ensures a positive working environment.
11. Performs other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Bachelor’s degree in business administration, healthcare administration or related field or equivalent experience in lieu of degree.
Preferred:
- Master’s degree in relevant area.
Experience
Required:
- Minimum 12 years relevant health care experience with 7 years management/leadership experience.
Preferred:
- Knowledge of Medicaid and Medicare reimbursement methodologies.
Language Skills
Required:
- English
Functional Competitencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent program management skills, with the capability to effectively manage program and processes across multiple areas of the organization.
SCOPE INFORMATION
# Direct Reports: 2-5
# Indirect Reports: 10-15
Budgetary $ Responsibility: yes, varies.
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
ermHO
Job ID 2013-22301 # Positions 1
Location US-NATIONWIDE
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 3/17/2013
Additional Locations ..
More information about this job:
Summary:
Ensures all aspects necessary to develop, maintain, and improve provider networks are met consistently to support the achievement of company goals. Functions include, but are not limited to, the identification, targeting, recruiting, contracting, and re-contracting with all types of providers including primary care physicians, specialist, hospitals, and allied services providers. Oversees strategic aspects concerning provider networks providing advice and guidance to the Health Plans. Responsible for maintaining compliance to company standards for areas influencing the management of provider networks. Provides leadership and development to team members within Network Development area.
Responsibilities:
1. Develops and recommends market specific provider network strategy to leverage opportunities and ensure achievement of organizational objectives.
2. Supervises the network development physician recruitment process and collaborates with multiple resources to convey opportunity and project a well-coordinated team.
3. Works collaboratively with the Plan and other cross functional areas to evaluate, recruit and contract with hospitals and organized provider groups.
4. Works collaboratively with finance in setting reimbursement guidelines including market specific models.
5. Creates continuity among all health plans in the areas of provider reimbursement, contracting, standards, and physician performance.
6. Negotiate provider contract language and reimbursement as needed.
7. Establishes standards, programs and process for provider network management, balancing best practices with knowledge of local market factors and needs to ensure success in all markets.
8. Works collaboratively with Business Development on new market development and entry.
9. Manages relationships with ancillary providers and ancillary vendors, and communicates contractual issues with appropriate enterprise departments.
10. Hires and develops staff, and ensures a positive working environment.
11. Performs other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Bachelor’s degree in business administration, healthcare administration or related field or equivalent experience in lieu of degree.
Preferred:
- Master’s degree in relevant area.
Experience
Required:
- Minimum 12 years relevant health care experience with 7 years management/leadership experience.
Preferred:
- Knowledge of Medicaid and Medicare reimbursement methodologies.
Language Skills
Required:
- English
Functional Competitencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent program management skills, with the capability to effectively manage program and processes across multiple areas of the organization.
SCOPE INFORMATION
# Direct Reports: 2-5
# Indirect Reports: 10-15
Budgetary $ Responsibility: yes, varies.
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
ermHO