Vice President, Network Management

General Search & Recruitement Published: February 9, 2018

Description

Vice President, Network Management

Chicago, IL

Our Client is a respected and financially strong insurance
carrier with a national presence.

You would have an opportunity to be part of the expansion of
this division if you were selected to join the leadership team.

Making a difference in healthcare is what we they do, are
you ready to be part of something unique?

You will oversee the development and management of the
provider networks (physicians, hospitals, and/or ancillary providers, etc.)
yielding a geographically competitive, broad access, stable network that
achieves objectives for unit cost performance and trend management, and
produces an affordable and predictable product for customers and business
partners.

The Vice President, Network Management evaluates and manages
Third-Party vendors to ensure compliance with company contract templates,
reimbursement structure standards, and other key process controls in order to
meet regulatory minimum network adequacy requirements.

Responsibilities:

You develop and implement network contracting and network
expansion strategies specific to local markets in the assigned regions, to
include identifying and cultivating strategic alliances and building new
network models with significant provider organizations.

You provides strategic design of high performance networks
to include provider performance incentives.

This includes managing Third-Party vendors and delivers
planned medical trends and high quality/large provider networks that support
business objectives for MLR, growth and income results.

This role requires collaborating and working with teams to
identify customers’ needs and to close network gaps.

You ensures compliance with all regulatory and accreditation
standards. Oversees provider services to include provider education and general
provider relations support.

Oversees and directs efforts across the company related to
provider network performance to achieve goals related to quality, financial,
and growth objectives.

Proactively develop and manage key metrics across all
aspects of network performance.

Requirements:

Requires a BA/BS Degree

8+ years progressively responsible related experience in
contract negotiation, network development and provider relations

Advanced level of knowledge of Medicare/Medicare Advantage
reimbursement methodologies

Advanced level of knowledge in AHCA and CMS guidelines.

Experience in building provider network for Managed Care
start-up health plans serving various populations, specially Medicare/Medicare
Advantage.

 

 

 

 

 

 

 

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