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VP, Provider Network Strategy & Contracting - RI at Commonwealth Care Alliance

Posted in Other 30+ days ago.

Type: Full Time
Location: Boston, Massachusetts





Job Description:

VP, Provider Network Strategy & Contracting - RI

Job ID

2020-3642

Category

Provider Contracting

Type

Regular Full-Time

Actual Work Location

30 Winter Street, Boston, MA

Why This Role is Important to Us

The Vice President for Provider Network Strategy and Contracting - RI (the VP) is responsible for building and maintaining a provider network aligned with the strategic growth objectives of the organization. Reporting to the General Manager, Health Plans, the VP leads Provider Contracting and Provider Relations. The VP leads the execution of reimbursement strategies, value based contracting, analytics and performance standards to enhance contractual relationships with key multi-disciplinary provider partners; leads the engagement and negotiation with diverse provider organizations; and ensures that contracting tactics foster efficient and effective implementation of the CCA care model through delegated and contracted providers. The VP ensures that execution aligns with strategic objectives coming from leadership.

What You'll Be Doing

Develop and implement an effective provider network as determined by key metrics as well as meeting all regulatory network adequacy standards for CCA's health plans.
- Establish and maintain effective business relationships with network providers on behalf of the organization.
- Ensure a provider analytics capacity to enhance CCA's ability to manage CCA and provider performance.
- Work with senior leadership at key health care providers and other entities as needed to promote shared marketing strategies and meet enrollment targets.
- Build and maintain relationships with CCA senior leaders and providers and other external partners including government, advocates, and stakeholders.
- Develop and coach staff to engage appropriately with providers in a strategic and meaningful way to achieve the strategic objectives of the company.
- Partner with finance/underwriting and legal departments to facilitate underwriting, pricing reviews, and contract negotiation with key strategic partners
- Work collaboratively with executive leadership to identify and act on new business opportunities aimed at growing CCA's provider network consistent with corporate goals and network adequacy strategies.
- Commit to continual improvement by providing executive leadership with feedback from the field, which will inform future provider network strategy development.
Secondary Responsibilities
In order to fulfill primary duties and responsibilities, convene and lead cross-functional workgroups to ensure an effective provider network to meet the company's growth and strategic objectives.
Lead the local team and liaise to home/ corporate structure as needed.
Other duties as assigned.

What We're Looking For

- Master's Degree or equivalent experience
- Master's degree in health care field strongly preferred.
- Minimum of 10 years of management experience in health care, business development, health care provider contracting, marketing and/or sales.
- Professional poise, confidence, and comfort with leading discussions with senior leadership, professional clinical staff, and others, including outside vendors, advocacy and government stakeholders and customers.
- Deep knowledge of health care marketplace and ability to bring the marketplace perspectives into CCA to educate colleagues.
- Ability to build strong relationships with providers.
- Excellent presentation skills on a wide range of content on CCA- to internal and external senior leaders, board of directors, and advocacy and government stakeholders.
- Experience in product pricing and utilizing financial modeling in making rate decisions.
- Experience in developing and managing medical cost and administrative budgets.
- Knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, and industry pricing tools.
- Understanding of quality and financial measures driving network effectiveness.
- Strong quantitative and analytic skills.
- Must be able to influence team members, business owners across different business units and senior leaders.
- Must act as a champion for team members and professionally develop staff.
- Demonstrated ability to develop and utilize an escalation path for an issue.
- Must be highly organized and self-directed with a proven ability to work independently.
- Must be able as a leader to foster an atmosphere of trust and respect.
- Exemplary communication skills, both verbal and written.
- Highly organized.
- Must demonstrate the ability to plan long term strategies.
- Requires excellent interpersonal skills in order to communicate and work with peers and staff of all skill and experience levels.
- Must be able to exercise a high level of diplomacy and be influential.
- Most work is performed in office but must have flexibility to meet with external parties at their locations as needed.
- Most work is performed in office but must have flexibility to meet with external parties at their locations as needed. Must be able to travel throughout Rhode Island.
- Must be proficient in the use of computers, specifically Microsoft Office suite. Must have ability to learn new systems and databases that CCA implements.
- Must have solid understanding of CCA's systems and how technology can be used to solve specific business problems
- Standard office equipment
- English required, bilingual preferred

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Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.


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