Lead Director, Network Management Value-Based Care
About The Position
This person must sit in FL or LA. Position Summary: This role will be accountable for the strategic alignment, operational success and performance management of assigned provider relationships with the most complex/high value initiatives and/or highest risk and revenue generating provider systems, network and value-based relationships. Ensures that assigned value based contract arrangements are functioning successfully and working to improve quality of care while reducing costs. Additionally, this position will include supervisory responsibilities for VBS Provider Performance team members. This role is strategically designed to provide dedicated leadership and oversight for Medicaid value-based care (VBC) initiatives across the Florida and Louisiana markets. This position carries broad responsibility for the development, execution, and oversight of Medicaid focused value-based contracting and provider performance strategies within these two key markets.
Requirements
- 10 years experience in a health plan, health system or provider organization, ACO / managed-care experience preferred
- Experience directly managing people and/or Teams
- Self-directed individual with independent problem-solving skills
- Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels
- Experience managing matrixed environment with ability to leverage internal business partners to complete tasks
- Good interpersonal and communication skills
- Knowledge of healthcare and insurance industry
- Ability to form strong client relationships
Nice To Haves
- Adept at collaboration and teamwork with both internal and external partners
- Experience with Provider Contracting, Plan Design and Product Offerings
Responsibilities
- Provider Relationship Management - Understands the terms of the value based contract arrangements to answer questions/address issues.
- Responsible for establishing and maintaining productive, professional relationships.
- Educates internal and external parties as needed to ensure compliance with contract terms and expectations
- Coordinates and prepares for external provider meetings and ensures that the most impactful internal subject matter experts (clinical, pharmacy, financial, analytical, etc.) are utilized to optimize performance. (External meetings include JOCs, clinical meetings, Informatics discussions, contract reconciliations, etc.)
- Assists with workflow development and strategies to integrate data and reporting
- Works independently to manage relationships and identify/implement solutions to problems
- Drives provider performance and partners with local market to ensure pathways to performance against business and team objectives
- Drives improvement in deal performance for multiple lines of business, complex models, and/or advanced national provider partners
- Leverages reporting/data to monitor contract performance against financial, clinical, cost and efficiency targets. Adept at identifying issues or trends in reporting.
- Assumes supervisory responsibilities for VBS Provider Performance team members
- Identifies improvement opportunities.
- Provides strategy consultation on actions/tactics to make needed improvements
- Assists Executive Director, Provider Performance, in developing and driving strategies to achieve organizational goals
- Serves as support and back-up to Executive Director, Provider Performance, as needed
- Drives and monitors consistency and adherence to policies/protocols of department
- Assists in identification and promotion of best practices within Team
- Identifies training and/or educational needs within Team
- Oversees training plan for new Team colleagues
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
Associate degree
