VP of Provider Relations and Contracting

Job Description Job Title : VP of Provider Relations and Contracting Reports To : Executive Director Location : Spring Valley, NY AND Brooklyn, NY Job Overview : Responsible for overseeing all provider relationships and contracting activities within the HIRING COMPANY Managed Care programs, including the Medicaid Managed Long Term Care (MLTC), Dual Special Needs Plan (DSNP), and Medicare Advantage Plans (MAP). This role involves developing, managing, and optimizing provider networks, fostering positive relationships with healthcare providers, and ensuring compliance with regulations and contractual obligations. The VP will work closely with senior management to drive strategic growth and operational excellence in these programs. Essential Responsibilities :

• Manage and mentor the provider relations and contracting team, fostering a high-performance culture.
• Foster and manage ongoing relationships with existing providers, ensuring their satisfaction and continued participation in the HIRING COMPANY Managed Care programs.
• Take primary responsibility for the credentialing of all providers within the network, ensuring compliance with regulatory requirements and organizational policies.
• Ensure the timely and accurate completion of the credentialing process, maintaining an up-to-date and compliant roster of providers.
• Provide oversight and monitoring of network adequacy requirements within the established contracts.
• Lead and manage the operational aspects of provider contracting, ensuring the timely and efficient negotiation and execution of agreements with hospitals, medical groups, and other key healthcare providers.
• Ensure that contracts meet organizational needs, comply with regulatory standards, and support program goals across MLTC, DSNP, and MAP lines of business.
• Oversee high-stakes, high-profile negotiations with healthcare entities, particularly large hospitals and healthcare systems. Use strategic negotiation tactics to secure favorable terms for the organization while fostering long-term, collaborative relationships with key providers
• Define and execute the strategic direction for provider relations and contracting within the Managed Care organization. Ensure provider relations strategies are aligned with organizational objectives and drive sustainable growth and improved member care.
• Ensure that the provider network is properly educated and compliant with all aspects of state, federal, and contractual requirements.
• Provide ongoing training and resources to providers to ensure they understand and meet regulatory and contractual obligation
• Works closely with the claims, care management, compliance and quality departments as necessary to develop protocols and resolve any issues / concerns.
• Collaborate with senior management and attend mandatory meetings
• Other duties as necessary Specific Knowledge, Skills, and Abilities :
• Strong negotiation and communication skills, with a proven ability to manage complex negotiations with large healthcare entities.
• Extensive knowledge of credentialing processes and operational contracting in the healthcare sector.
• Ability to use data and analytics to monitor performance and identify areas for improvement.
• Leadership experience in managing and developing teams, with a focus on fostering a collaborative, high-performance environment
• Ability to work in a highly collaborative team environment Required Education, Experience, and Licenses :
• At least 5 years of experience in provider relations, contracting, or network management within managed care, with a strong focus on operational contracting, provider relationship management, and credentialing.
• Significant experience in high-profile contract negotiations with hospitals, healthcare systems, and large medical group Powered by JazzHR