The Vice President, Provider Networks, plays a critical leadership role in shaping and managing the strategic direction of provider network operations. This position is responsible for developing and maintaining strong relationships with a diverse range of health care providers to ensure high-quality, cost-effective care delivery to members. The role involves overseeing network adequacy, contract negotiations, and provider performance management to optimize network value and patient outcomes. The Vice President will lead cross-functional teams to implement innovative strategies that align with organizational goals and regulatory requirements. Ultimately, this role drives the growth, efficiency, and sustainability of the provider network to support the organization's mission and business objectives.
Minimum Qualifications:- Bachelor's degree in Health Administration, Business, or a related field.
- At least 10 years of progressive experience in provider network management within the health care industry.
- Proven experience in contract negotiation and provider relationship management.
- Strong knowledge of health care regulations, payer-provider dynamics, and network adequacy standards.
- Demonstrated leadership experience managing cross-functional teams and driving strategic initiatives.
- Relevant experience may substitute for experience on a year-for-year basis.
Preferred Qualifications:- Master's degree in Health Administration, Business Administration, or a related discipline.
- Experience working within managed care organizations or health plans.
- Familiarity with value-based care models and population health management.
- Certification in health care management or related professional credentials.
- Experience with data analytics tools and health care information systems.
Responsibilities:- Lead the development and execution of provider network strategies to meet organizational goals and regulatory standards.
- Manage contract negotiations and renewals with health care providers, ensuring favorable terms and compliance.
- Oversee provider network performance, including quality metrics, cost management, and member satisfaction.
- Collaborate with internal teams such as claims, medical management, and compliance to ensure seamless network operations.
- Build and maintain strong relationships with providers, industry partners, and regulatory bodies to support network growth and innovation.
- Analyze market trends and competitor activities to identify opportunities for network expansion and improvement.
- Develop and manage budgets, forecasts, and performance reports related to provider network operations.
- Lead, mentor, and develop a high-performing team focused on provider relations and network management.
