The Vice President of Network Contracting will serve as a single point of accountability for all externally related network activity, i.e. contracting, network adequacy and access, provider relations, network builds, new business implementation support, client audits and value based payment arrangements) related to their assigned region. The incumbent will work in close alignment with the regional Market President, Chief Operating Officer, Chief Partnership Officer, Chief Financial Officer and the Clinical Vice President for the assigned region they support to ensure access to quality behavioral health services.
* Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management. * Define network configuration to meet projected member access, utilization and budget requirements in all geographic regions pursued by the organization and region. * Negotiate and coordinate contractual, operational and service requirements for facility, group, and individual behavioral health providers. * Develop functional, market level and/or site strategy, plans, production and/or organizational priorities. * Identify and resolve technical, operational and organizational problems, aggressively seeking opportunities to improve departmental workflows and increase efficiencies. * Direct work that impacts entire functions and/or customer accounts (internal and external). * Manage a team of negotiators to meet the needs of the health plan objectives and/or targets. * Promote positive relationships with a multitude of network providers. * Maintain a thorough understanding of all provider contract language -- identify and coordinate needed revisions. * Consult with appropriate regulatory entities and legal counsel as necessary to proactively address, resolve or clarify contractual issues. * Assure that the network(s) meet applicable standards of all products. * Maintain integrity of provider data including multiple enterprise and governmental systems as well as written documentation of provider network. * Ensure compliance with departmental and corporate performance metrics. * Ensure timely on-boarding, including credentialing activities that are compliant with governmental 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, professional development and strategic as well as tactical management. * Prepare performance, statistical, and other operational reports. * Prepare/meet annual budget to support business plans.
* Minimum of 10 years of experience in Healthcare network contracting, payment or network performance management * Minimum of 5 years of experience in a Leadership or Executive role * Significant experience using analytics to measure and improve Provider and Health Plan Performance * Advanced knowledge of claims data analytics * Advance knowledge of Provider cost, utilization and quality measurement * Demonstrated knowledge and experience with Healthcare Providers * Experience with Healthcare network building and management * Experience with alternative/value based pricing * Outstanding negotiation skills * Client management experience * Experience with budgets and financial management * Proactive problem solver focused on quality improvement * Demonstrated strategic and critical thinking skills * Experience building and managing high performing teams * Persuasive and executive level communication skills * Strong initiative and proven organizational skills
Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
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Associated topics: accounting, analyst, audit, budget, cfa, cpa, financial controller, kpmg, revenue, treasure
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.