Vice President, Network - R011391

Overview

Develops the overall Provider Network contracting strategy for all Health Plans Networks and associated Provider Relations Department, which includes contracting, orientation and servicing of all Physician, Ancillary, Nursing Homes, LHCSAs, and Hospital Providers rendering care to VNS Health Plans. Oversees the development of incentives, processes, policies and procedures for network development and performance to ensure alignment and support of the company's various product offerings. Works collaboratively with operations to resolve provider issues. Ensures compliance with all state and federal regulations, as well as VNS Health Plans policies and procedures. Works under general direction.

Compensation:

$193,600.00 - $258,200.00 Annual

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs 
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care  
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement 
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities  
  
  

What You Will Do

• Develops and implements network strategy and drives provider management opportunities that support achievement of member growth and increased quality and efficiency, including Value Based Payment contracting. Identifies and recommends best practices for operational improvements and performance for Health Plans.
• Performs an integral role in the review and management of unit cost structures and achievement of overall MLR targets (Medical Loss Ratio); works closely with Health Plans leadership, finance, and clinical areas to review network and provider performance and identify unmet service needs to ensure overall satisfaction, especially with the Health Plans IPAs and key providers that align with growth strategies; recommends new/corrective actions as appropriate.
• Leads the development and negotiation of contractual relationships with external vendors and manages the oversight of relationships. Leads and executes relationship strategy with IPA and PCP partners to drive growth, quality, and financial performance. Ensures performance metrics are achieved; identifies and implements opportunities for improvement.
• Leads the development and implementation of strategies to meet network capacity and regulatory requirements. Works with other VNS Health Plans departments and business units to coordinate their roles or requirements in provider contracting, network performance, reimbursement and other related matters.
• Assesses network requirements as defined by VNS Health Plans CE leadership for enhancements or future product offerings. Monitors and analyzes network needs through review of provider utilization, member demands, program staff’s requests, provider performance, market trends and other information. Implements changes and improvements, as appropriate.
• Directs all provider recruitment activity. Works with Product teams to identify providers and develop provider recruitment and orientation strategies based on network requirements of each product line. Oversees the recruitment process to identify and establish relationships with various service providers.
• Identifies common issues affecting provider networks; works with Account Management staff and health plan colleagues in developing solutions.
• Ensures compliance with all regulatory reporting requirements to SDOH and CMS, including but not limited to Health Provider Network (HPN), Health Services Delivery (HSD), Medicare Part C reporting, and provider directories.
• Maintains visibility in the provider community by attending provider-sponsored events, seminars and conferences.
• Works with Quality and Clinical Management Department to ensure quality assurance monitoring of network providers.
• Keeps abreast of current industry trends, governing regulations, reimbursement practices and market players. Keeps VNS Health Plans management informed of trends/changes and makes recommendations based on this information.
• Performs all duties inherent in a senior managerial role. Approves staff training, hiring, promotions, terminations, and salary actions. Prepares and ensures adherence to department budget.
• Participates in special projects and performs other duties as assigned.
  
  

Qualifications

Education:

• Bachelor's Degree in Business, Health Administration, Health Policy, a related discipline or the equivalent work experience required
• Master's Degree in Business, Health Administration, Health Policy or related discipline required
  
  

Work Experience:

• Minimum ten years of experience in health care, with a minimum five years in a managed care environment and five years in health care management required
• Experience negotiating hospital, IPA, Nursing Homes, LHCSAs and provider contracts required
• Experience negotiating risk and Value Based Payment contracts required