Job Details

Requisition Number 20-1053
Post Date 10/22/2020
Title Vice President, National Provider Networks
City Dayton
State OH
Description

Role and Responsibility:

  • Execute network strategy to meet projected member access, utilization and budget requirement in all geographic markets and regions
  • Assure that networks meet applicable standards of all market and product regulators
  • Collaborate to design and implement innovative payment methodologies for deployment to providers
  • Identify partnership opportunities with providers of all types in new and existing markets
  • Develop and promote positive mutually beneficial relationships with a multitude of disparate network providers in target markets
  • Consult with applicable regulatory entities and legal counsel as necessary to negotiate, resolve and clarify contractual issues in multiple markets
  • Assure provider contracts meet all regulatory standards in each market
  • Ensure the creation and maintenance of policies and procedures as they relate to the management of the department and areas of focus
  • Ensure compliance with departmental & corporate performance metrics
  • Maintain a thorough understanding of all provider contract terms and language -- identify and coordinate needed revisions
  • Maintain integrity of provider contract data including multiple enterprise and State systems
  • Ensure timely on-boarding of providers, including credentialing activities that are compliant with State and accrediting body requirements and provider load that is reflective of documented provider participation and provider agreement intent
  • Comply with all accreditation standards of URAC and the National Committee for Quality Assurance (NCQA)
  • Lead/manage staff, including recruitment and selection, development and strategic and tactical management
  • Prepare/meet annual budget to support business plans
  • Prepare performance, statistical, and other operational reports
  • Collaborate across departments and functions to assure quality outcomes
  • Perform any other job related duties as assigned
Requirements

Education / Experience:

  • Bachelors’ degree in a business-related field or equivalent experience is required
  • Masters’ Degree is preferred
  • Minimum of seven to ten (7-10) years in managed care, with at least five (5) years in leadership is required
  • Strong background and experience in all aspects of health care, including marketing, network development, finance and state regulatory guidelines
  • Concentration in provider network contracting of large, complex, matrixed provider organizations and specialty services
  • Multi-state provider contracting experience is preferred
  • Managed Medicaid, Medicare Advantage, DSNP and Marketplace experience is preferred

Required Competencies / Knowledge / Skills:

  • Microsoft Office tools
  • Strategic and forward thinking; ability to lead within a matrixed organization
  • Proven ability to negotiate with and develop strong relationships with hospitals and providers
  • Ability to design and deploy innovative approaches to provider reimbursement
  • Ability to manage a large, diverse staff
  • Strong leadership and management skills
  • Strong communication skills
  • People management skills
  • Ability to work independently and within a team environment
  • Attention to detail and follow through
  • Expertise within healthcare field
  • Critical listening and thinking skills
  • Training/teaching skills
  • Customer service oriented
  • Decision making/problem solving skills
  • Collaboration skills

Working Conditions:

  • General office environment; may be required to sit/stand for long periods of time
  • 50-75% travel may be required

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.

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This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.
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