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Job Summary

This position is responsible for directing, coordinating and controlling the development, implementation, maintenance and operational effectiveness of all aspects of provider network and contracts in Illinois and in border areas. This position is accountable for overseeing the successful implementation of all Illinois fee-for-service and value-based strategies via contracting with providers statewide. This position is responsible for developing and overseeing statewide Facility, Ancillary, and Professional Network contracting staff; overseeing the maintenance of multiple broad and narrow network development and management serving both commercial and government programs; overseeing the maintenance and operations of all HMO products, Medicare Advantage and emerging Medicaid networks; assuring that contracts with providers are in accordance with established standards and State, Local, and Federal regulatory requirements; develop appropriate provider incentive arrangements, value based care model (ex ACO, medical home) development and implementation.

Additionally, this position is responsible for leading the financial and operational aspects of Illinois network activities including professional reimbursement modeling and reporting; fee for value payments; facility cost audits, reconciliation and operations of the Illinois Facility backend system.

Job Responsibilities:

• Lead all aspects of provider network and staff, including but not limited to: network management, adequacy and access analysis, network operations, regulatory requirements, and support data-driven decision making related to reimbursement and unit cost management

• Create and maintain strong relationships with Illinois health care providers in order to advance company goals and objectives with those relationships, arrangements and partnerships.

• Oversee and lead the coordination and negotiation for the provider contracting department.

• Establish the department’s strategic vision, objectives and goals, and policies and procedures.

• Oversee the network development and operations staff and external consultants in the development of new provider networks and network expansions.

• Perform recurring review of the provider network from a cost, coverage, and growth perspective.

• Provide leadership in evaluating opportunities to expand or change the network to meet organizational goals.

• Manage and review claim trend data for products and networks and strategically negotiate provider contracts accordingly.

• Ensure positive team engagement, foster psychological safety and ensure appropriate collaboration and integration across all functions.

Required Job Qualifications:

• 15 years experience with complex, multi-faceted network arrangements including dealing with hospitals and hospital systems and with physicians, multi-specialty groups and IPAs either from the payor or provider prospective.

• Experience in negotiating effectively in difficult and stressful situations.

• Experience in strategy development, implementation.

• Understanding of managed care programs (HMO and PPO) and emerging care models (ACO and Medical Home) as they relate to various types and sizes of healthcare facilities and to physicians whether they are independent, in an IPA, in a multi-specialty group or part of a system.* Knowledge of negotiating techniques.

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HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.