What are the responsibilities and job description for the Director Network Contracting & Provider Strategy position at MedStar Medical Group?
Responsible for the overall direction and management of the contracting value-based care (VBC) and network development strategies for the District of Columbia. Responsibilities include negotiating provider reimbursement rates and contract terms, developing value-based care arrangements, planning, directing, organizing and evaluating the implementation of strategic objectives to ensure access to a quality cost efficient comprehensive provider network. Oversight and monitoring of network development and provider contracting. Ensures that cost containment initiatives are met for the health plan. Formulates and implements policies and procedures to ensure compliance with applicable regulatory, contractual and accreditation standards and requirements. Acts as corporate authority on all reimbursement and payment methodologies, including incentive and Value-Based Care programs for the District of Columbia and Maryland health plans. Additionally, leads activities with other internal departments to provide optimal customer service to network providers and internal customers. Develops and oversees provider education program. Provides management, direction, development, problem resolution and leadership for the provider relations team
Education
Bachelor's degree in related field required and
Master's degree in business or in health care administration preferred
Experience
8-10 years Experience in managed care / health care required and
5-7 years Experience with state and federal programs such as medicaid and medicare is beneficial. Experience with provider pay-for-performance programs preferred. APR-DRG hospital reimbursement methodology and claims adjudication systems is required. significant experience managing networks and provider relations for primary care and specialty network, with a focus on access to care. required
5-7 years experience in supervisory capacity required
Licenses and Certifications
No special certification, registration or licensure required
Knowledge, Skills, and Abilities
Strong analytical skills.
Strong written and verbal communication skills and experience with formal presentations.
Superior problem solving, decision making and negotiation skills.
Ability to prioritize and managed multiple projects.
Proficiency with word processing, database spreadsheet programs, and database applications.
Work requires demonstrated experience in the managed care environment; such as an Integrated Medical System in an administrative or finance setting or managed care organization / Insurance Company.
Must have analytical and strong financial skills, contracting knowledge
Must have experience with data analysis and statistics.
Requires proven experience engaging providers in meaningful dialogue that results in collaborative relationships to support quality and financial initiatives.
Knowledge of complex managed care concepts, including provider recruitment, network development, and managed care contractual process; including alternative reimbursement models associated with incentive and risk-based programs.
Demonstrated knowledge of value-based care reimbursement models. Healthcare contract experience in commercial and government contracting.
Knowledge of multi-state and federal regulatory requirements. Broad contracting experience in unregulated markets.
Has responsibility for the oversight of network development, recruitment, contracting and retention activities.
Develops contract negotiation strategy to meet Strategic Goals.
Manages Provider Relations department to include day to day operations, hiring and performance evaluations. Assists in development and growth in essential job functions and performance standards. Includes development and monitoring of performance metrics and goals for the provider relations team in collaboration with the MedStar Family Choice District of Columbia leadership team. Provides guidance on development, performance, and productivity. Recommends changes to improve efficiency and effectiveness.
With guidance, develops and expands MedStar Family Choice's Value- Based Care program by partnering with health care systems within DC and Maryland; implement programs and strategies related to manage care contracts.
Leads, develops and implements alternative payment methodologies (shared savings, risk sharing bundle arrangements).
Collaborates with key stakeholders, including finance, health plan leaders, operations and legal, to manage financial and operational, and legal provisions of the contracts. Implement contracting processes to effectively manage and maintain contract proposal, renewals and analysis, contract execution and configuration.
Has knowledge of government programs with a specific focus on Medicaid.
Assesses market readiness in targeted states for network development and expansion.
Ensures compliance with state and federal regulatory requirements related to applicable state laws.
Provides supervision and mentoring of Provider Relations and contracting team
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