Vice President

Description:

The VP, Network Development and Contracting is accountable for overseeing the successful development and implementation of corporate-wide value-based strategies and in FFS/Value Based Contracting efforts with providers statewide. The position is accountable for the strategic vision and administration of pay-for-performance reward pools and upside/downside risk arrangements.

The position oversees the Provider Network Analytics department to monitor, report KPIs, create dashboards and produce analyses of network adequacy and disruption, care patterns costs of care, quality outcomes and publish provider data management standards. This position also is responsible for ancillary fee-for-service negotiations for the organization statewide including, network development activities, contracting template standards, rate negotiations, and value-based programs pertinent to provider contracting.

Essential Functions - Vice President, Network Development and Contracting
Creates the health plan’s operating model for the strategy and implementation of special value-based programs contracts that favorably differentiate the network from competitor.
Develop and oversee Priority Health’s value-based healthcare strategy statewide including the development of specific programs and value-based reimbursement structures, operational processes and administration, IT investments, vendor relationships, supplemental data feeds, etc.
Integrates Priority Health and Corewell Health value-based initiatives to ensure that overlapping IT solutions and processes are consolidated to avoid redundancy and achieve optimization of cost-effective population health management. This includes but is not limited to population health IT investments, managed care analytic platforms, HEDIS engine, and provider data management vendor relationships.
Manages statewide the Provider Analytics function for the division including the development of negotiating models, fee schedule development, disruption analyses, capitation payments, discount repricing, etc.
Lead the development, negotiation, and implementation of broad based, tiered and narrow network products and value-based contract arrangements. Also lead medical cost reduction programs to identify network cost savings and unit cost improvement opportunities, develop action plans, and successfully implement them.
Cultivate and maintain productive relationships with key hospitals, physician medical groups, organized provider organizations and ancillary vendors. As appropriate, oversee negotiation strategies and lead or participate in negotiations with key providers. Serve in leadership positions on key community boards of directors and statewide professional/industry organizations.
Lead, motivate and manage the Provider Contracting team of professionals responsible for the development and implementation of negotiating strategies, financial analyses, and performance improvement strategies to ensure Priority Health meets its financial performance targets. Recruit high performing and motivated talent to key positions; train and develop workforce of top performing people; reward, recognize and manage performance as appropriate.
Work with and involve relevant stakeholders (Provider Network Performance, Reimbursement and Life cycle, Value-Based Payment Department, and Finance and Operations) in major negotiation decisions impacting legal or regulatory requirements, contract standards and cost targets.
Provide advice/guidance/recommendations to executive management and business partners regarding health care costs, cost savings opportunities, best practices, provider performance issues, provider compensation, and network expansion.
Develop and implement annual budget for the Provider Contracting Department in accordance with corporate and regional targets, and monitor/manage the actual performance.
Ensure the integrity of Priority Health’s provider network with company policies and ensure compliance with pertinent regulatory and accreditation guidelines.
Oversee and guide the development and maintenance of purposeful, long-term relationships with providers based on fair and competitive business terms, with an emphasis on improving quality and the patients' experience of care, reducing the cost of care and risk adjustment performance. Scope of responsibility entails all Priority Health products including; HMO Commercial, PPO Commercial, Medicare, Medicaid, and product segments like Individual and ASO.
Design breakthrough strategies to ensure Priority Health is the industry leader in pay for performance programs, clinical outcomes, and cost effectiveness and ensure that the network engagement strategy is fully and continuously integrated with day-to-day operations, renewals, and the medical trend management strategy.
Oversee and direct collaborative efforts with providers in designated communities to identify improvement opportunities, develop action plans and then successfully implement them.
Contribute to the development of provider payment strategies and utilization management programs.
Lead, motivate, and manage the team responsible for implementing the Network Engagement strategy within assigned book of business. This includes the recruitment of high performing and motivated talent to key positions. In addition, monitor the interface between team members and network providers to ensure annual goals are achieved.
Provide advice/guidance/recommendations to corporate and regional executives and business partners related to various risk arrangements, costs, cost-savings opportunities, best practices, provider performance issues, provider compensation and network expansion.
Support market specific business needs for designated communities including the development of new plan designs to support strategic objectives in addition to responding to purchaser requirements.
Responsible for the business planning process that entails the coordination of provider facing activities from across the organization. Also responsible for programs and initiatives targeted at the improvement in provider experience and service leading to greater affinity between Priority Health and participating Providers.
Qualifications - Vice President, Network Development and Contracting
Required Bachelor's Degree health care administration, business administration, accounting, finance, health/human services or related field.
Preferred Master's Degree business administration, health care administration or related field preferred; or law degree.
10 years of relevant experience leadership experience Required