Director, Network Contracting - Healthcare

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 12 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

Arizona Priority Care strives to be the network of choice for health plan partners, physicians, and employers and the Director of Network Contracting plays a critical role in ensuring high levels of provider satisfaction. This position will direct a team responsible for managing network development and provider contracting, as well as develop, execute, and maintain a comprehensive provider network. This individual will work with senior leadership to develop strategies to meet organizational goals, market growth, and medical cost targets.

POSITION DUTIES & RESPONSIBILITES

• Leads the development of provider network business plans, goals, and objectives.
• Develops and oversees a cost effective and compliant provider network contracting process.
• Continuously reviews network performance based on utilization and membership trends to identify and close network gaps.
• Continuously reviews network adequacy meets all CMS and Payer time and distance requirements.
• Ensure health plan and regulatory language included in provider contracts.
• With support from senior leadership, develops contracting-pricing standards and ensures negotiations fall within minimum financial targets.
• Negotiates, develops, and directs single case agreements/letters of agreement as necessary to ensure continuity of care for patients needing out of network care.
• Ensures coordination with claims and clinical services to ensure timely identification of contracting needs and concerns as they may occur.
• Ensures timely communication of all elements of new or revised provider contract information to the provider data management team for proper loading of individual providers and/or information, as applicable.
• Directs the negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines with physicians, hospitals, and other health care providers; ensuring timely review of contract renewals, negotiations, as appropriate.
• Contributes as a key member of the senior leadership team and other committees addressing the strategic goals of the department and organization.
• Oversees the maintenance of all Provider Contract Information and Provider Contract Templates.
• Works with legal and Corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
• Achieves company targets for primary care, specialty, hospital, and ancillary provider contracting.
• Manages Network Integrity and compliance.
• Maintains strong working relationships with key payers, hospital systems, and ancillary vendors.
• Schedules and participates in regular joint operations meetings to identify and resolve operational issues.
• Responds to health plan contract requests.
• Ensures accurate & timely provider data information in conjunction with timely notification to health plans. Monitor and ensure health plan partners update and complete changes in a timely manner.
• Actively promotes AZPC brand through professional and community affiliations.
• Assists in identifying and engaging in business development opportunities.
• Maintains provider directory web page to ensure information is available to providers on a timely basis.
• Collaborates and assists Provider Relations & Marketing departments with network specific initiatives.
• Manages budgeting and forecasting and ensure department targets are established and maintained.
• Manages network staff and prioritizes activities as necessary.
• Some travel in your personal vehicle to health plan/provider offices and events.

EDUCATION, TRAINING AND EXPERIENCE

• Bachelor’s degree or equivalent experience in Business Administration, Healthcare Administration or related field. MBA/MHA preferred. 10 years’ experience in managed care network development and provider relations/contracting management in a health care or managed care environment.
• Develops and maintains key provider relationships in the market
• Experience Negotiating all provider type agreements (hospital, physician and ancillary)
• Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
• Excellent oral and written communication skills.
• Strong interpersonal and collaborative skills (experience working in a consensus building and matrix environment a plus).
• Demonstrated experience and knowledge of CMS managed care contracting requirements.

*All positions require 60 days FT in-office presence, before hybrid options will be available*