VP, Network Strategy & Contracting(Preferred Managed Care Experience And Must Live In Nevada)

CareSource•Nevada WFH, NV

7d•$150,000 - $300,000•Onsite

About The Position

The VP, Network Strategy & Contracting is responsible for creating and executing the Market Network strategic plan including leading the market with Value Based Purchasing initiatives that differentiate and enable the market to excel, including Pharmacy, Retail and Behavioral Health initiatives. This role involves leading and influencing stakeholders such as the Department of Medicaid, Legislators, and health partners to create competitive advantages for CareSource. The position requires meeting and exceeding projected member access, product, utilization, and budget requirements across all geographic regions, leveraging traditional, virtual, and delegated partner providers. The VP will assure that the network(s) meet applicable standards for all Plan products, design and implement recruitment plans, and directly negotiate and coordinate contractual, operational, and service requirements for hospitals, physicians, and ancillary providers. Additionally, the role focuses on improving departmental workflows, increasing efficiencies, promoting positive provider relationships, completing provider surveys, consulting with regulatory entities and legal counsel on contractual issues, and ensuring contracts meet all regulatory standards. Compliance with Model Audit Rules (MAR) and accreditation standards (URAC, NCQA) is essential. The position also involves leading and managing staff, preparing and meeting annual budgets, and preparing operational reports.

Requirements

Bachelors’ degree in a business-related field or equivalent experience is required
Minimum of seven (7) years in of experience in the health care field is required
A minimum of five (5) years of Senior Leadership experience is required
Strong background and experience in all aspects of health care, including marketing, network development, finance and state regulatory guidelines is required
Must Live in Nevada

Nice To Haves

Masters’ Degree is preferred
Multi-state provider contracting experience is preferred
Proficiency in Microsoft Word, PowerPoint and Excel

Responsibilities

Create and execute the Market Network strategic plan including leading the market with Value Based Purchasing initiatives that differentiate and enable the market to excel, including Pharmacy, Retail and Behavioral Health initiatives
Lead and influence stakeholders including the Department of Medicaid, Legislators, health partners and other stakeholders to create competitive advantages for CareSource and to fully understand the macro models being established or considered in the market and nationally
Meet and exceed projected member access, product, utilization and budget requirements in all geographic regions pursued by the Plan, leveraging traditional, virtual and delegated partner providers
Assure that the network(s) meet applicable standards of all Plan products
Design & implement recruitment plans and directly negotiate and coordinate contractual, operational and service requirements for hospitals, physicians and ancillary providers
Aggressively seek opportunities to improve the departmental work flows and increase efficiencies
Promote positive relationships with the multitude of network providers
Complete provider surveys periodically to identify opportunities for Plan improvement
Consult with applicable regulatory entities and legal counsel as necessary to address, resolve or clarify contractual issues. Assure contracts meet all regulatory standards
Comply with the Model Audit Rules (MAR) standards
Ensure the creation and maintenance of policies and procedures as they relate to the management of the department
Ensure compliance with departmental & corporate performance metrics
Maintain a thorough understanding of all provider contract language -- identify and coordinate needed revisions.
Maintain integrity of provider data including multiple enterprise and State systems as well as written documentation of provider network.
Ensure timely on-boarding, including credentialing activities that are compliant with State and accrediting body requirements.
Comply with all accreditation standards of URAC and the National Committee for Quality Assurance (NCQA).
Lead/manage staff, including recruitment and selection, development and strategic and tactical management including excelling at employee engagement
Prepare/meet annual budget to support business plans.
Prepare performance, statistical, and other operational reports.
Perform any other job related instructions as requested