Our Client is a respected and financially strong insurance carrier with a national presence. You would have an opportunity to be part of the expansion of this division if you were selected to join the leadership team. Making a difference in healthcare is what we they do, are you ready to be part of something unique?
You will oversee the development and management of the provider networks (physicians, hospitals, and/or ancillary providers, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners.
The Vice President, Network Management evaluates and manages Third Party vendors to ensure compliance with company contract templates, reimbursement structure standards, and other key process controls in order to meet regulatory minimum network adequacy requirements.
You develop and implement network contracting and network expansion strategies specific to local markets in the assigned regions, to include identifying and cultivating strategic alliances and building new network models with significant provider organizations.
You provide strategic design of high performance networks to include provider performance incentives.
This includes managing Third-Party vendors and delivers planned medical trends and high quality/large provider networks that support business objectives for MLR, growth and income results.
This role requires collaborating and working with teams to identify customers’ needs and to close network gaps.
Ensures compliance with all regulatory and accreditation standards. Oversees provider services to include provider education and general provider relations support.
You will oversee and direct efforts across the company related to provider network performance to achieve goals related to quality, financial, and growth objectives.
Proactively develops and manages key metrics across all aspects of network performance.
Requires a BA/BS Degree
8+ years progressively responsible related experience in contract negotiation, network development and provider relations
Advanced level of knowledge of Medicare/Medicare Advantage reimbursement methodologies
Advanced level of knowledge in AHCA and CMS guidelines
Experience in building provider network for Managed Care start-up health plans serving various populations, speciatly Medicare/Medicare Advantage