Reports To: Vice President, Network Operations
Manages: Senior Provider Contracting Specialist or Contracting Provider Specialist
Purpose: To implement and manage the ConnectiCare's value-based network and provider collaboration strategy.
1. Leads a multidisciplinary team to develop and implement value based network strategies to include preferred treatment sites, bundled pricing, ACO development, Centers of Excellence, Patient Centered Medical Home, value-based pay for performance and other initiatives.
2. Defines the measures of success for the strategic provider partnerships, works with medical management and other departments to develop the tools to monitor success of programs, provide meaningful data to providers to manage population and reports to senior management on the results of each group.
3. Develops systems and reporting mechanisms to provide timely and accurate performance measurement to the broad-based provider networks. Works with other team members to coordinate reporting activities around physician profiling and P4P scorecards. Implements appropriate strategies based on data.
4. Contracts the terms with strategic provider partners around the value based network strategies.
5. Establishes cost benchmarks for each strategic model to assist in successfully meeting or exceeding budgetary requirements.
6. Tracks, trends and reports financial and other quantitative and qualitative data on a regular and as needed basis for internal discussion and decisions.
7. Develops and maintains positive relationships with contracted provider partners.
8. Performs other related projects and duties as assigned.
TECHNICAL KNOWLEDGE, EXPERIENCE AND SKILL REQUIREMENTS:
1. Bachelors Degree required. Masters Degree in Business or Healthcare strongly preferred.
2. At least 8 years healthcare management experience in strategic planning, project management, provider contracting, medical management or health plan finance required.
3. Experience with measurement reporting, performance and provider profiling required.
4. Excellent oral and written communication and interpersonal skills required.
5. Strong understanding of healthcare reimbursement methodologies from an operational and financial perspective.
6. Ability to function productively in a multidisciplinary, relatively unstructured environment.
7. Excellent analytic and problem solving skills utilizing both an individual and team approach.
8. Working knowledge of personal computers to include basic word processing and spreadsheet products.
9. Excellent negotiation and influencing skills.
10. Able to travel within a defined geographic area.
1. Active Leadership: Leaders refine direction, consistently achieve results and create an environment of trust and respect. They demonstrate the ability to influence people to want to achieve the goals and objectives of the organization. They recognize and reward performance, their feedback to subordinates on performance is transparent, honest and on-going.
2. Member & Customer Focus: Recognizes that members and customers (internal & external) are the driving force behind every business activity and makes an effort to continuously exceed the expectations of members and customers.
3. Quality Orientation: Assumes responsibility for providing the highest level of quality to members and customers.
4. Results Orientation: The ability to break a complex problem down into its component parts and arrive at the appropriate solution in a timely fashion.
5. Innovation/Continuous Process Improvement: The ability to see opportunities for change, to capitalize on them and implement them when appropriate for the benefit of the organization.
6. Communication: The ability to communicate effectively with others in a timely, clear and transparent manner to enhance business relationships and facilitate sound decision making.
7. Teamwork: Effectively collaborates with others and demonstrates enthusiasm for the mission of the organization, inspires the same in others.
8. Learning Orientation: Assumes responsibility for personal and professional development, is proactive in learning new ideas and methods.
ConnectiCare is an equal opportunity employer. M/F/D/V
ConnectiCare - 20 months ago
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