VP Provider Relations - Plan
Job ID 2013-24256 # Positions 1
Location US-TX-Houston
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 9/23/2013
Additional Locations ..
More information about this job:
Summary:
Lead all aspects of Provider Network Management to include provider network strategy, provider contracting, provider relations and operations to support provider service, network development, provider education, and product and market expansions. Responsibilities include the strategic analysis and negotiations for network management, including organizational management, complex contracting, and contracting efforts to support MEIs. Provider Network Management includes all aspects of interaction with claim centers, Business Solutions, HCMS, QI and Service Center Operations. The Provider Relations VP may also work closely with our client or regulatory partners to achieve high level of compliance and customer satisfaction. It is further expected this leadership position is a key part of the health plan leadership team supporting important operational and leadership aspects of the health plan.
Responsibilities:
1. Responsible for managing and improving network management operations to achieve or exceed performance standards/budgets.
2. Leads the development of provider network business plans, strategies and goals.
3. Responsible for hiring, developing, training and retaining high-quality, productive employees.
4. Develops and manages provider contracting efforts and partnerships to achieve quality, cost management, and strategic business development objectives.
5. Assists the CEO/COO with aspects of local and state government relationships, including dealing with regulators as necessary to establish and continue effective working relationships.
6. Effectively represent AGP in interaction and negotiation with the provider network.
7. Collaborate with health plan senior management to identify and align provider contracting efforts with the goals and objectives of the plan and AGP.
8. Lead or assist in the development of Provider network related earnings improvement initiatives.
9. Lead the execution of provider network business plans, strategies and goals.
10. Monitor local market trends relative to Provider contracting, reimbursement and service, make recommendations to modify current processes and lead or assist with implementing changes when necessary.
11. Responsible for managing required regulatory compliance for provider networks.
12. Liaison to home office personnel to ensure that provider credentialing, maintenance and reimbursement is properly maintained.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- College degree.
Preferred:
- Advanced degree.
Years and Type of Experience Required:
Required:
- Minimum ten (10) years experience in managed care, with minimum eight (8) years in managed care administration, and two (2) years in executive management.
Specific Technical Skills
Required:
- Demonstrated experience with team management and performance improvement.
- Strong understanding of the healthcare industry, managed care and health plan operations
Specific Technical Skills
Preferred:
- Experience leading a company or division with a distinct P and L is considered a positive.
- Experience with government programs preferred.
- Knowledge of Medicaid reimbursement methodologies is desired.
- Experience in large, complex negotiations and contracting efforts.
- Documented success in operational management.
- Ability to successfully interact with senior executives of the AGP organization as well as community
- Healthcare clinical professionals and business executives nationwide.
- Self starter and goal oriented.
- Computational and analytical skills related to Provider contracting and healthcare cost management.
- Ability to establish a strategic vision, set expectations and provide clear direction to individuals or departments being managed.
- Respect for and ability to work well with all levels within the organization and within the Provider community.
- Appreciation of cultural diversity and strong sensitivity towards target member population.
- Excellent communication, organizational and project management skills.
- Ability to prioritize and execute multiple complex projects in various markets simultaneously.
- Ability to complete projects/assignments accurately, on-time, on-budget and with a minimum amount of supervision.
- Understanding and appreciation of legal and regulatory environment relative to Provider Relations.
Certifications or Licensure
Required:
- Current driver’s license, and at minimum, state required amount of automobile insurance for state where automobile is licensed.
Other:
Required:
- Respect for and ability to work well with all levels within the organization and within the Provider community.
- Appreciation of cultural diversity and strong sensitivity towards target member population.
- Excellent communication, organizational and project management skills.
PHYSICAL REQUIREMENTS
- Must be able to travel on common carriers, drive an automobile and adhere to AGP’s travel policy.
- Must be able to operate a computer, telephone and other commonly used business-related items.
Options:
- Apply for this job online
- Email this job to a friend
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Job ID 2013-24256 # Positions 1
Location US-TX-Houston
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 9/23/2013
Additional Locations ..
More information about this job:
Summary:
Lead all aspects of Provider Network Management to include provider network strategy, provider contracting, provider relations and operations to support provider service, network development, provider education, and product and market expansions. Responsibilities include the strategic analysis and negotiations for network management, including organizational management, complex contracting, and contracting efforts to support MEIs. Provider Network Management includes all aspects of interaction with claim centers, Business Solutions, HCMS, QI and Service Center Operations. The Provider Relations VP may also work closely with our client or regulatory partners to achieve high level of compliance and customer satisfaction. It is further expected this leadership position is a key part of the health plan leadership team supporting important operational and leadership aspects of the health plan.
Responsibilities:
1. Responsible for managing and improving network management operations to achieve or exceed performance standards/budgets.
2. Leads the development of provider network business plans, strategies and goals.
3. Responsible for hiring, developing, training and retaining high-quality, productive employees.
4. Develops and manages provider contracting efforts and partnerships to achieve quality, cost management, and strategic business development objectives.
5. Assists the CEO/COO with aspects of local and state government relationships, including dealing with regulators as necessary to establish and continue effective working relationships.
6. Effectively represent AGP in interaction and negotiation with the provider network.
7. Collaborate with health plan senior management to identify and align provider contracting efforts with the goals and objectives of the plan and AGP.
8. Lead or assist in the development of Provider network related earnings improvement initiatives.
9. Lead the execution of provider network business plans, strategies and goals.
10. Monitor local market trends relative to Provider contracting, reimbursement and service, make recommendations to modify current processes and lead or assist with implementing changes when necessary.
11. Responsible for managing required regulatory compliance for provider networks.
12. Liaison to home office personnel to ensure that provider credentialing, maintenance and reimbursement is properly maintained.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- College degree.
Preferred:
- Advanced degree.
Years and Type of Experience Required:
Required:
- Minimum ten (10) years experience in managed care, with minimum eight (8) years in managed care administration, and two (2) years in executive management.
Specific Technical Skills
Required:
- Demonstrated experience with team management and performance improvement.
- Strong understanding of the healthcare industry, managed care and health plan operations
Specific Technical Skills
Preferred:
- Experience leading a company or division with a distinct P and L is considered a positive.
- Experience with government programs preferred.
- Knowledge of Medicaid reimbursement methodologies is desired.
- Experience in large, complex negotiations and contracting efforts.
- Documented success in operational management.
- Ability to successfully interact with senior executives of the AGP organization as well as community
- Healthcare clinical professionals and business executives nationwide.
- Self starter and goal oriented.
- Computational and analytical skills related to Provider contracting and healthcare cost management.
- Ability to establish a strategic vision, set expectations and provide clear direction to individuals or departments being managed.
- Respect for and ability to work well with all levels within the organization and within the Provider community.
- Appreciation of cultural diversity and strong sensitivity towards target member population.
- Excellent communication, organizational and project management skills.
- Ability to prioritize and execute multiple complex projects in various markets simultaneously.
- Ability to complete projects/assignments accurately, on-time, on-budget and with a minimum amount of supervision.
- Understanding and appreciation of legal and regulatory environment relative to Provider Relations.
Certifications or Licensure
Required:
- Current driver’s license, and at minimum, state required amount of automobile insurance for state where automobile is licensed.
Other:
Required:
- Respect for and ability to work well with all levels within the organization and within the Provider community.
- Appreciation of cultural diversity and strong sensitivity towards target member population.
- Excellent communication, organizational and project management skills.
PHYSICAL REQUIREMENTS
- Must be able to travel on common carriers, drive an automobile and adhere to AGP’s travel policy.
- Must be able to operate a computer, telephone and other commonly used business-related items.
Options:
- Apply for this job online
- Email this job to a friend
Go back to the welcome page
Need further assistance·
Powered by the iCIMS Talent Platform (Opens new window)
Applicant Tracking Software
ermHO