Job Summary:The AVP, Hospital and Integrated Delivery System (IDS) Network Contracting provides leadership for the Massachusetts market's provider contracting strategy across hospitals, health systems, and related physician organization networks. The AVP is responsible for developing and executing network and reimbursement strategies that ensure competitive access, affordability, quality, regulatory compliance, and value-based performance.
Essential Functions:- Develop and execute the Massachusetts contracting strategy for hospitals, integrated delivery systems, and related physician organization networks.
- Lead in the establishment of contracting priorities, performance expectations, succession planning, and talent development.
- Balance network adequacy, affordability, quality outcomes, member access, and provider relationships while achieving financial targets.
- Ensure competitive reimbursement methodologies are deployed, including value-based arrangements, shared savings, and risk-based contracts where applicable.
- Partner with Finance, Actuarial, Clinical, Legal, Compliance, Medical Management, and Executive Leadership to align contracting strategy with enterprise objectives.
- Analyze market dynamics, competitive intelligence, utilization trends, and regulatory changes to identify strategic opportunities and risks.
- Build and maintain executive-level relationships with provider organizations, regulators, and community stakeholders.
- Perform any other job related duties as requested.
Education and Experience:- Bachelor's Degree required
- Master's Degree in Business or Health Care preferred
- Ten (10) years of progressively responsible healthcare provider contracting experience. required
- Extensive experience negotiating complex hospital, physician, and integrated delivery system agreements. required
- Seven (7) years of leadership experience managing contracting teams and senior leaders. preferred
- Experience with Medicare Advantage, Medicaid, Dual Eligible programs, and value-based payment models preferred
Competencies, Knowledge and Skills:- Executive leadership and strategic planning
- Complex provider negotiations and executive influence
- Financial acumen and reimbursement modeling
- Knowledge of provider network strategy, regulatory requirements, and value-based care
- Exceptional communication, executive presence, and relationship management
- Data-driven decision making and analytical skills
- Change leadership and organizational transformation
- Ability to build high-performing, accountable teams
- Conflict resolution and consensus building
- Strong project, portfolio, and stakeholder management
Licensure and Certification:- Professional certification (HFMA, ACHE, or similar) preferred
- 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
- Regular movement between multiple building sites will be required.
Must be able to work a flexible schedule to support changing and emerging physical security protection situations. - 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.#LI-RW1
Brand=CareSource
