Senior Director - Network Contracting & Provider Relations

Confidential Company  •  New York City, NY and New York, NY

8 - 10 years experience  •  Managed Care & Health Insurance

Salary depends on experience
Posted on 02/26/18 by Paul Pascale
Confidential Company
New York City, NY
8 - 10 years experience
Managed Care & Health Insurance
Salary depends on experience
Posted on 02/26/18 Paul Pascale



Brighton Health Plan Solutions

Job Title:


Senior Director, Delivery Systems Collaborations



Network Management

About Us:

Brighton Health Plan Solutions (BHPS) is an innovative health plan management Company with several industry-leading products including Create, MagnaCare, and Brighton Casualty Solutions ? all working to transform the health planexperience. By bringing outstanding products and services to our partners, we are focused on changing how health care is accessed and delivered, and committed to aligning incentives with our partners in unique and meaningful ways. As the health plan management division of Brighton Health Group, BHPS serves employers, plan sponsors, commercial insurers, TPAs, government entities, labor markets and otherstakeholders in the New York, New Jersey, and Connecticut marketplace.

Company Mission:

Transform the health planexperience? how health care is accessed and delivered ? by bringing outstanding products and services to our partners.

Company Vision:

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways. 

About this Role

This is an opportunity for a motivated relationship-driven professional to drive a strategic approach to provider network development, help us grow our network solutions and support our healthcare delivery system partners across the tri-state area. We?re seeking a leader to join our team to recruit, retain and manage provider networks including hospitals and physician groups, to implement new products, organize delivery system partners with value-based incentives, re-contractwith existing providers to ensure cost effective and competitive arrangements, and identify/secure new agreements with providers. The Senior Director of Delivery Systems Collaborations will also coordinate withother teams to incorporate a strategic approach to provider network development.

Reporting to the President of Network, this role can be based out of our Westbury, New York City, or New Jersey office locations.    

Job Responsibilities:

  • Lead strategy for hospitals, physicians, and accountable care organizations to determine network composition, reimbursement, and approach to grow and deliver value.
  • Lead value-based incentive design, reconciliation, and delivery with integrated delivery systems, as assigned.
  • Review, negotiate, implement and maintain existing hospital, ancillary and professional rate schedules and contractual language.
  • Evaluate effectiveness and viability of existing and prospective contract arrangements.
  • Develop alternative payment methodologies, e.g. performance based deals, risk, capitation, etc.
  • Implement new and evolving strategic contract initiatives.
  • Assist in resolution of provider issues, including root cause analyses, problem solving, and strategic relevance to the organization and its clients.
  • Provide routine reports tracking development, activity, and issues.
  • Represent brands (MagnaCare, Create) to provider community in the New York metro area and promote positive working relationships.
  • Work effectively with team of contractors and other team members.
  • Lead at least one Contract Manager, with the potential to supervise others.

 Essential Qualifications:

  • Minimum 7years in a provider contracting role.
  • Strong understanding of professional, diagnostic provider and hospital cost structures.
  • Sound knowledge of healthcare industry contracting methodologies.
  • Demonstrated analytical & negotiation abilities, with excellent communication and presentation skills.
  • Work independently and exhibit entrepreneurial skills and instincts, coupled with ability to work within the boundaries of corporate strategy and policy.
  • Highly developed organization and planning skills, including time and project management skills.Superior decision making abilities.
  • Ability to develop and promote positive working relationships internally and within the provider community.
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