Director of Contracting – Value Based and Affiliated Networks

Corewell Health • Grand Rapids, MI

1d • Onsite

About The Position

Job Summary Directs and monitors the overall performance of provider network development and contract administration. Accountable for the production and implementation of accurate, timely and competitive contacts that reflect all applicable legislative and competitive standards. Develops and assists in the development of network contracting strategies on reimbursement, risk and incentive programs. Directs and is involved in service area expansion activities, including developing strategies for and negotiation with new provider networks. Internally, must work directly with strategic leaders of the company to ensure strategic support for expansion efforts and ability to administer contract arrangements. Externally, engages with health care organizations, CFO's and Director of Contracting to negotiate and finalize contracted arrangements. Works directly with or coordinates all matrix functions (e.g. Operations, Marketing, Utilization Management, Quality Management and Information Services) critical to Network Development. Essential Functions Directs the requisite provider contracting and network development activities within his/her assigned region, through the management of provider contracting teams; such management includes talent selection, development and performance evaluations. Develops and assists with the development of strategic initiatives relating to provider networks, including service area expansions, new payment and incentive methods, risk arrangements and new products. Sustains a successful team among Provider Contract Administrators to facilitate information sharing, optimal use of each PCA's strengths, background and experience to continuously improve provider contracting initiatives. Develop and maintain a comprehensive provider network (hospitals, physicians, ancillary) to deliver a full range of health care services to Priority Health members through recruitment, negotiation, contracting and re-contracting of providers to ensure quality, cost effectiveness and their participation in all products. Lead contracting efforts for new products and new service areas. Analyze, plan and assure provider network adequately meets access needs across all geographic areas. Develop and implement strategies for physician and hospital reimbursement. Communicate internally and externally regarding all provider related issues. Participate on key interdepartmental committees throughout the organization. Analyze, plan and assure provider network adequately meets access needs across all geographic areas for all lines of business and oversee the submission process. Develops strategic initiatives relating to value based and affiliated networks including necessary contract template revisions. Collaborate with Actuary team to set annual value-based targets and to assure that value-based arrangements are within budget and pricing limits. Lead contracting efforts and support for value based as well as affiliated networks .

Requirements

• Bachelor's Degree or equivalent
• 5 years of relevant experience in managed care with an emphasis on provider contracting, payment methodologies and new market development

Nice To Haves

• Master's Degree or equivalent

Responsibilities

• Directs and monitors the overall performance of provider network development and contract administration.
• Accountable for the production and implementation of accurate, timely and competitive contacts that reflect all applicable legislative and competitive standards.
• Develops and assists in the development of network contracting strategies on reimbursement, risk and incentive programs.
• Directs and is involved in service area expansion activities, including developing strategies for and negotiation with new provider networks.
• Internally, must work directly with strategic leaders of the company to ensure strategic support for expansion efforts and ability to administer contract arrangements.
• Externally, engages with health care organizations, CFO's and Director of Contracting to negotiate and finalize contracted arrangements.
• Works directly with or coordinates all matrix functions (e.g. Operations, Marketing, Utilization Management, Quality Management and Information Services) critical to Network Development.
• Directs the requisite provider contracting and network development activities within his/her assigned region, through the management of provider contracting teams; such management includes talent selection, development and performance evaluations.
• Develops and assists with the development of strategic initiatives relating to provider networks, including service area expansions, new payment and incentive methods, risk arrangements and new products.
• Sustains a successful team among Provider Contract Administrators to facilitate information sharing, optimal use of each PCA's strengths, background and experience to continuously improve provider contracting initiatives.
• Develop and maintain a comprehensive provider network (hospitals, physicians, ancillary) to deliver a full range of health care services to Priority Health members through recruitment, negotiation, contracting and re-contracting of providers to ensure quality, cost effectiveness and their participation in all products.
• Lead contracting efforts for new products and new service areas.
• Analyze, plan and assure provider network adequately meets access needs across all geographic areas.
• Develop and implement strategies for physician and hospital reimbursement.
• Communicate internally and externally regarding all provider related issues.
• Participate on key interdepartmental committees throughout the organization.
• Analyze, plan and assure provider network adequately meets access needs across all geographic areas for all lines of business and oversee the submission process.
• Develops strategic initiatives relating to value based and affiliated networks including necessary contract template revisions.
• Collaborate with Actuary team to set annual value-based targets and to assure that value-based arrangements are within budget and pricing limits.
• Lead contracting efforts and support for value based as well as affiliated networks

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here .
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees