VP, Network Development & Contracting - Sunshine State Health Plan
About The Position
Oversee provider network and contracting related activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the contracting department, including analysis of various information to support contract negotiations. Ensure development of provider networks across expansion markets. Evaluate provider network cost, coverage, and growth and recommend expansion opportunities. Oversee budgeting and forecasting initiatives for various product lines to networks costs and provider contracts. Review provider contracting rates to ensure strategic focus is on target with overall company strategy. Participate in unit cost and selective contracting initiatives. Establish the department’s strategic vision, objectives, and policies and procedures, including developing, implementing, and maintaining production and quality standards. Support market expansion and M&A activities by leading provider contract analysis related to due diligence. Assist health plan CEO and/or COO vendors in key provider relations and strategy. Performs other duties as assigned. Complies with all policies and standards.
Requirements
- Bachelor's Degree or equivalent, in Business Administration, Healthcare Administration or related field required.
- 10+ years of network development and provider relations or contracting management in a health care or managed care environment required.
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
- Valid driver’s license.
Nice To Haves
- MBA or MHA degree preferred.
- All contracting for Medicaid, Medicare and Marketplace lines of business covering the FL market.
Responsibilities
- Oversee provider network and contracting related activities.
- Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management.
- Oversee the coordination and negotiation for the contracting department, including analysis of various information to support contract negotiations.
- Ensure development of provider networks across expansion markets.
- Evaluate provider network cost, coverage, and growth and recommend expansion opportunities.
- Oversee budgeting and forecasting initiatives for various product lines to networks costs and provider contracts.
- Review provider contracting rates to ensure strategic focus is on target with overall company strategy.
- Participate in unit cost and selective contracting initiatives.
- Establish the department’s strategic vision, objectives, and policies and procedures, including developing, implementing, and maintaining production and quality standards.
- Support market expansion and M&A activities by leading provider contract analysis related to due diligence.
- Assist health plan CEO and/or COO vendors in key provider relations and strategy.
- Performs other duties as assigned.
- Complies with all policies and standards.
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules.
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What This Job Offers
Job Type
Full-time
Career Level
Executive
