Position Purpose: Direct the provider network and contracting activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the contracting department.
Establish the department’s strategic vision, objectives, and policies and procedures.
Develop, implement and maintain production and quality standards for the Contracting department.
Oversee network development staff and external consultants in the development of provider networks across expansion markets.
Perform periodic analyses of the provider network from a cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet Company goals.
Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts.
Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.
Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy.
Support market expansion and M&A activities by leading provider contract analysis related to due diligence.
Assist health plan CEO and/or COO vendors in key provider relations and strategy.
Education/Experience: Bachelor's degree or equivalent experience in Business Administration, Healthcare Administration or related field. MBA or MHA degreepreferred. 10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.