LOCATION: Columbia, SC
DEPARTMENT: Network Development
REPORTING TO: Market VP
Directs a team in managing physician contracting and network development. Develops, executes and maintains a provider network strategy for all Lines of Business. Works in concert with medical management and sales to develop strategies to meet market growth and medical cost targets. Provides service and education to network physicians/providers.
- Leads a team in developing and executing strategic departmental initiatives.
- Achieves company growth and financial targets through aggressive IPA, primary care, specialty and ancillary provider contracting as well as value based contracting initiatives.
- Performs and Manages ACO and MCO development and contracting as necessary.
- Performs and Manages required Hospital Contracting as appropriate.
- Monitors primary care and specialty risk arrangements for Medicaid, and Medicare product lines.
- Performs data analysis and develops specific actions to manage medical cost trend.
- Develops best practice to assist risk partners in managing financial risk.
- Identifies areas to improve provider service levels.
- Educates/enhances relationships within the provider community.
- Manages Network integrity and compliance.
- Special projects as assigned or directed.
- Required A Bachelor's Degree in Business, Healthcare or related field
- Required or equivalent work experience with directly related hospital and/or network contracting experience beyond the 5-7 years required
- Preferred A Master's Degree in a related field
- Required 7 years of experience in healthcare sector (preferably at HMO or PPO)
- Required 5 years of experience in HMO provider/hospital/ancillary contracting and network development
- Required 4 years of management experience
- Intermediate Demonstrated organizational skills
- Intermediate Demonstrated leadership skills Disciplined, hands-on and process-oriented leader
- Intermediate Demonstrated ACO and MCO development and contracting skills.
- Intermediate Other Ability to manage complex transaction and service models
- Intermediate Other Demonstrated proficiency in establishing and driving medical cost management programs
- Advanced Other Knowledge of regulatory requirements concerning Medicare and Medicaid
- Advanced Other Knowledge of provider contracts and health care reimbursement
- Advanced Other Understanding of regulatory compliance management and reporting requirements
- Advanced Other Ability to negotiate effectively with internal/external stakeholders, large hospital and physician healthcare systems