VP Business Development Network Strategy(Preferred Experience In Managed Care & Network Development)

CareSource • Dayton, OH

46d • $150,000 - $300,000

About The Position

Job Summary: The Vice President, Network Strategy & Development is responsible for developing and leading all aspects of network development strategy activities in new and expansion markets that are targeted for business development and growth procurements. Essential Functions: Responsible for provider contracting including hospital, physician, ancillary, non-traditional provider, LTSS and SDOH provider / partner contracting to facilitate optimal member access, successful business growth initiatives and sound plan financial performance as it relates to unit pricing in targeted states, regions, or markets Responsible for the development of networks in new and expansion markets or for new programs (e.g. DSNP; LTSS; and HCBS waiver population managed care expansion) Responsible for gaining provider network participation commitments that can be included in RFP responses; may be required to complete provider network builds prior to RFP Develop a contracting strategy for various markets targeted for business development opportunities Effectively uses LOIs, LOAs contracts or other agreements as necessary through various stages of a procurement process Can drive outcomes to successfully meet network requirements for purposes of developing an RFP, meeting readiness review compliance, or other business deliverable as indicated Responsible for building compliant and saleable networks for Medicare and Marketplace for target markets in the business development pipeline Ensure a high level of network adequacy and compliance for readiness when a new market is awarded Ensure that the provider setup for new markets or regions is consistent with the CareSource standards Collaborate with Market Network team to transition management of the network to the Market once the Market goes live Responsible for national ancillary strategy and contracting team and ensuring team drives execution of national ancillary provider service model Responsible for supplemental vendor network strategy and vendor management team that drives our national vendor business strategies and operations Oversee team of development directors and ensure areas of accountability are meeting performance and key operational metrics to drive organization success Willing to travel extensively to achieve results in targeted markets and programs Perform any other job duties as requested Education and 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 provider network development and vendor contracting / management, with at least five (5) years in leadership is required Managed Medicaid, Medicare Advantage, DSNP and Marketplace experience is preferred Competencies, Knowledge and Skills: Proficient in Microsoft Office tools Strong time management and prioritization skills, with the ability to manage multiple network builds simultaneously 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 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 Licensure and Certification: 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 and verified insurance. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated. 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. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process. Working Conditions: General office environment; may be required to sit or stand for extended periods of time 50 – 75% travel may be required Compensation range $150,000-$300,000. CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Energize and Inspire the Organization Influence Others Pursue Personal Excellence Understand the Business 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

• Bachelors’ degree in a business-related field or equivalent experience is required
• Minimum of seven to ten (7-10) years in provider network development and vendor contracting / management, with at least five (5) years in leadership is required
• Proficient in Microsoft Office tools
• Strong time management and prioritization skills, with the ability to manage multiple network builds simultaneously
• 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
• 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
• 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 and verified insurance. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated.
• 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. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.

Nice To Haves

• Masters’ Degree is preferred
• Managed Medicaid, Medicare Advantage, DSNP and Marketplace experience is preferred

Responsibilities

• Responsible for provider contracting including hospital, physician, ancillary, non-traditional provider, LTSS and SDOH provider / partner contracting to facilitate optimal member access, successful business growth initiatives and sound plan financial performance as it relates to unit pricing in targeted states, regions, or markets
• Responsible for the development of networks in new and expansion markets or for new programs (e.g. DSNP; LTSS; and HCBS waiver population managed care expansion)
• Responsible for gaining provider network participation commitments that can be included in RFP responses; may be required to complete provider network builds prior to RFP
• Develop a contracting strategy for various markets targeted for business development opportunities
• Effectively uses LOIs, LOAs contracts or other agreements as necessary through various stages of a procurement process
• Can drive outcomes to successfully meet network requirements for purposes of developing an RFP, meeting readiness review compliance, or other business deliverable as indicated
• Responsible for building compliant and saleable networks for Medicare and Marketplace for target markets in the business development pipeline
• Ensure a high level of network adequacy and compliance for readiness when a new market is awarded
• Ensure that the provider setup for new markets or regions is consistent with the CareSource standards
• Collaborate with Market Network team to transition management of the network to the Market once the Market goes live
• Responsible for national ancillary strategy and contracting team and ensuring team drives execution of national ancillary provider service model
• Responsible for supplemental vendor network strategy and vendor management team that drives our national vendor business strategies and operations
• Oversee team of development directors and ensure areas of accountability are meeting performance and key operational metrics to drive organization success
• Willing to travel extensively to achieve results in targeted markets and programs
• Perform any other job duties as requested

Benefits

• In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
• We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Number of Employees: 1,001-5,000 employees