Identifies prospects, negotiates and manages contractual relationships with practitioners, facilities and vendors that provide institutional and home based care services to members enrolled in long term care managed care programs; effectively and professionally representing the enterprise to the provider community and other external stakeholders.
Reports to: VP, Network Performance
Dept.: CNS-Enterprise Network Performance
Location: Tampa, FL
Additional Responsibilities:Candidate Education:
- Develops, negotiates and manages provider contracts for a set of long term care services and provider types including but not limited to: long term and post-acute nursing facilities, assisted living, independent living Geriatric Support/Long Term Care Service Coordination, adult day care, adult foster care, group adult foster care & group homes, homemaker/personal care services, meals, respite care and all other community based services
- Ensures that all contracts meet market financial budgetary targets, as well as all legal and regulatory requirements.
- Maintains solid understanding of Medicare and Medicaid reimbursement methodologies, competitive landscape for LTC/LTSS relative to network partnerships, payment models and network innovations.
- Ensures network adequacy for all required services including adherence with all state and federal regulatory requirements.
- Conducts on-going assessments of assigned provider network types and puts forth recommendations for strategic improvements.
- Supports RPF process as necessary to ensure timely, successful bid submissions.
- Leads and/or participates in cross-functional meetings and projects related to assigned provider types and serve as the company-wide subject matter expert on long term and home based care providers and related services.
- Required A Bachelor's Degree in a related field
- Preferred A Master's Degree in a related field
- Required 7 years of experience in the healthcare sector (preferably at HMO or PPO)
- Required 5 years of experience in Long term and home based contracting and vendor relations experience
- Required 4 years of experience in in leadership position(s)
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated written communication skills
- Advanced Demonstrated customer service skills
- Advanced Demonstrated analytical skills
- Advanced Demonstrated negotiation skills
- Advanced Demonstrated organizational skills
- Advanced Ability to influence internal and external constituents
- Advanced Other Demonstrated negotiation and contract development skills with long term and home based care providers and vendors
- Advanced Other Ability to work in a self-directed manner environment and manage competing and changing priorities
- Intermediate Other Knowledge of regulatory requirements concerning Medicare and Medicaid
- Advanced Other Ability to identify unusual variation in costs and to assess impact of change
- Intermediate Other Ability to identify unusual variation in costs and to assess impact of change Ability to remain calm under pressure
- Required Intermediate Microsoft Visio
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft PowerPoint