VP, Head of Provider Network Management

Job Description

Job Description

Purpose

Reporting to the President and CEO, the VP, Head of Network Management is accountable for leading HNE’s provider partnerships and provider network strategy, including provider contracting, provider experience, provider network operations, provider contracting analytics, risk sharing provider relations and credentialing. In this role as part of the Executive team, the VP, Head of Network Management leads and implements network strategy focused on optimizing performance, driving a competitive cost position, insuring compliance with all network requirements and delivering on strategic goals across all lines of business.

Accountabilities

• Oversight of all provider contracting and provider relations activities (including joint ventures and high- performance network arrangements).
• Responsible for the development and implementation of the company’s strategic provider contracting initiatives. Leads negotiations with key provider partners. Works closely with clinical and other areas in the development of quality and clinical measures for providers.
• Facilitates the execution of network management goals by working with other Executive and Leadership Team members to ensure that network goals are clearly established and communicated and easily understood by all throughout the organization.
• Acts as a key advisor to the organization on critical changes in the competitive landscape, monitors need for network changes, whether driven by regulatory, new product or competitive reasons, and adjusts the network accordingly. Tracks innovations in types of partners and partnership that may benefit HNE’s members, such as partners managing SDoH.
• Ensures that all provider network and contracting programs are monitored and reviewed for compliance with all applicable regulatory agencies as well as the appropriate credentialing organizations (i.e. NCQA). Ensures that cross-area planning and implementation of activities in the areas of quality and compliance occur.
• Collaborates with the Chief Medical Officer and the Medical Services division to facilitate contracted provider collaborations designed to improve efficiency and effectiveness of medical care. Leverages HNE clinical and operational expertise to identify requirements for selecting Value-Based partners and collaborates with the Quality Department and the Population Health Department in the oversight of quality incentive programs. In collaboration with Finance, analyze potential contracting arrangements and determine terms and methodologies that engage the network and support HNE market goals and operational capabilities.
• Working through technology, data analytics, and clinical leadership, ensure HNE uses and shares data effectively to promote provider collaboration and effectiveness.
• Responsible to negotiate provider contracts that support the company’s overall financial and strategic objectives.
• Oversight and management of all vendors responsible for meeting HNE’s network and clinical obligations.
• Oversight and responsibility for day to day operations of Provider Contracting, Credentialing, Provider Relations, Provider Appeals, and Network Management

Reporting Relationships (Job Titles only)

Manager : (include secondary Manager if applicable)

Direct Reports :

Shared Reports (solid / dotted if applicable) :

Working Relationships

Internal

External

Dimensions

Education / Experience / Other Information (include only those that are specific to the role)

Master’s degree in in Health Administration, Public Health, Business Administration or a quantitative field of study (e.g., mathematics, economics, sciences, finance, etc.) with a minimum ten years’ of progressive professional management experience, including at least 5 years managing other managers. Knowledge of Medicare, commercial and Massachusetts Medicaid products highly preferred.

At least 5 years of leadership experience with provider contracting, network management or provider reimbursement in a health plan or insurance company

Working Conditions