AVP, Network and Contracting

CareSource

5d•$150,000 - $300,000

About The Position

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. Establishes and sustains 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. 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. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SW2 The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.

Requirements

Bachelor's degree in related field required
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
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
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.
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position.
CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment.

Nice To Haves

Master's degree preferred

Responsibilities

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.