Vice President, Network Management

Martin’s Point Health Care

110d

About The Position

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of 'people caring for people,' Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a 'Great Place to Work' since 2015. Position Summary Reporting to the General Counsel and Chief Legal Officer, the Vice President, Network Management works closely and collaboratively with the Executive Management team, peer Vice Presidents, and other health plan leaders to support the growth and success of the portfolio of providers in the Martin’s Point Health Plan network. The Vice President, Network Management is responsible for leading all aspects of Provider Network Management including the development of our provider network strategy, provider contracting, provider relations and operations to support provider service, network development, provider education, and product and market expansions. This position will plan, direct, and organize strategic provider engagement activities with health systems, hospitals and provider groups to ensure effective support for improving the health outcomes of health plan members, improving the quality of care and service they receive and reducing the total cost of care. This position provides operational leadership to the provider relations, credentialing, provider data management and reporting areas as well as provider operational areas including fee schedule management and data integrity. The successful candidate provides direction and oversight to all provider network development and maintenance as well as coordination and deployment of reimbursement operations. This position works in concert with the other areas of the organization to support provider engagement across multiple internal functional areas, including close coordination with clinical, finance, and risk adjustment leaders. Additionally, the Vice President Network Management is a key contributor to the organization’s strategic processes providing input for corporatewide provider initiatives and partnering with key business areas such as the Martin’s Point Delivery System.

Requirements

• Bachelor’s degree required; Master’s degree preferred.
• 10+ years experience in managed care with comprehensive experience in network operations and the deployment of managed care contracting and reimbursement methodologies.
• Contract negotiations and relationship management experience and demonstrated win-win results.
• Experience with management of diverse teams or departments including remote locations.

Nice To Haves

• Knowledge of TRICARE and Medicare Advantage benefits preferred.
• Strong provider contracting knowledge across provider spectrum (hospital, physician, ancillary).

Responsibilities

• Leads the health plan in the design and development of new provider relations strategies and contractual relationships to support the growth and performance objectives of the health plan, including existing and new value-based payment models.
• Partners with other health plan leaders to support provider engagement through collaboration and alignment of goals.
• Leads the provider teams to ensure the contractual relationships that Martin’s Point has with its health plan network providers are meaningful and effective partnerships that balance the best interests of Martin’s Point’s members, providers and our organization.
• Supports the tracking and evaluation of health system, hospital and provider group performance, including quality, experience and total cost of care.
• Develops strong, collaborative relationships across the organization.
• Ensures that the Network Management Department has the appropriate skills and expertise to meet the ongoing business initiatives; and create future leaders and staff bench strength within the team.
• Strategically aligns resources by continuously planning and organizing to meet initiatives.
• Leads teams to achieve effective maintenance of provider systems and processes to enhance performance and support accurate and complete provider demographic data in all managed care transactional systems and web-based portals, through quality control monitoring and improvement processes.
• Effectively develops, tracks, reports and communicates operational metrics to track the department performance against prescribed goals.
• Ensures compliance with applicable regulatory and internal requirements, including network reports for the department and other internal or external clients, regulators and accrediting bodies.
• Establishes quality control mechanisms for processes and continuously strives to improve operational efficiency through process redesign and data driven evaluation of performance.
• Collaborates on and coordinate activities with other departments in the Health Plan and other divisions at Martin’s Point Health Care to promote the network and the members it serves.
• Ensures provider education activities are done in a timely and cost-effective manner to continuously improve relationships with network providers and the delivery of care to our membership.
• Ensures execution of all credentialing functions, vendor oversight and coordination of clinical credentialing committee activities as well as delegated credentialing through provider groups.

Benefits

• 401k
• health_insurance
• dental_insurance
• vision_insurance
• paid_holidays
• paid_volunteer_time
• flexible_scheduling
• professional_development

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Bachelor's degree
• Number of Employees: 501-1,000 employees