AVP, Network and Contracting

Job Summary:

The Associate Vice President, Network and Contracting is responsible for the planning, execution, and strategic plan to build hospital, provider and ancillary provider contracting, service, and provider data integrity to facilitate optimal member access, successful business growth initiatives and sound plan financial performance.

Essential Functions:

• Oversee Provider’s Contracting and Network operational strategy for assigned market, ensuring outcomes are measurable and aligned as part of a data informed strategy that ensures overall quality and compliance with State and Federal requirements.
• Develops and maintains a market-specific Provider Reimbursement Strategy consistent with Reimbursement Tolerance Parameters (across multiple specialties/geographies); Oversee the development of new reimbursement models and approval process for Health Plan exceptions for all lines of business.
• Establish and sustain relationships with regulatory agencies (e.g., Department of Medicaid, CMS, etc.) and other stakeholders to identify and create competitive advantages for CareSource.
• Manages strategic positioning for provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements.
• Oversee complex contracts and negotiations for fee for service and value-based reimbursements with hospitals and other providers.
• Collaborate with market and enterprise committees and workgroups to ensure alignment and overall implementation of assigned market strategy.
• Lead and develop a high‑performing contracting team, creating a culture of growth, collaboration, and accountability.
• Meet or exceed projected member access, product, utilization and budget requirements in all geographic regions pursued by the Plan, leveraging traditional, virtual and delegated partner providers.
• Collaborate with the market Executive team to ensure provider contracting and network performance related to CareSource enterprise and Market strategies, contractual, policy, and state/federal programs.
• Collaborate, innovate and support provider approaches to address contract compliance, industry supported contract requirements and financial alignment.
• Collaborate with Enterprise and Market leadership on the development of overall program strategy and business objectives with respect to Provider Contracting and Network.
• Develops and maintains Contract Negotiation tracking system, ensuring accurate and timely contract loading, submissions, and network implementation activities, and develops and delivers enterprise-wide training for contract management system
• Ensure budget and financial goals are set in conjunction with the Market executive team.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree in related field required
• Master's degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Ten (10) years experience in health care external stakeholder and community program support, project and program management; complex business processes, strategic and business planning or related required
• Five (5) years of prior management experience required

Competencies, Knowledge and Skills:

• Proficient in Microsoft Excel, Word, PowerPoint and Excel
• Critical listening and systematic thinking skills
• Planning, problem identification and resolution skills
• Business process/management skills
• Strong financial background
• Ability to maintain confidentiality and act in the company’s best interest
• Strong oral, written, and interpersonal communication skills
• Excellent leadership, management and supervisory skills and experience
• Energetic, enthusiastic, and politically astute
• Ability to act with diplomacy and sensitivity to cultural diversity
• Responsive to a changing environment
• Strategic deployment and management skills
• Conflict resolution skills
• Knowledge of regulatory reporting and compliance requirements
• Proficiency with provider engagement, performance improvement and operations
• Ability to work with multi-disciplinary departments across the organization
• Demonstrated ability to develop, prioritize and accomplish goals
• Strong interpersonal skills and high level of professionalism
• Ability to work independently and within a team environment

Licensure and Certification:

• Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unaccep