Director Of Provider Network Development

This role reports to the SVP Provider Relations and Contracting, with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions and to directly meet the organization's requirements.

This role will manage a team of 6 across NY State consisting of Physician and Caregivers Engagement Representatives and administrative staff. All members of the team participate in contracting new healthcare providers into the system, including the Director.

This role is remote based (work from home) and will require approximately 35% travel throughout NY State

Primary Responsibilities

Director of Provider Network Development will have the following responsibilities:

Accountable for developing and advancing a coordinated approach to recruit and/or acquire primary care practices, develop expansion, new product and partnership strategies across the provider and payer portfolio for Medicare and Medicaid product lines with payers, as a sub-contractor within other networks and directly with Federal and State Governments (ACO REACH).

• This position works in partnership with local and national leadership to develop, execute and advise on IPA network development, PCP acquisitions, contracting provider partnership strategies and opportunities for growth/payer pull-through initiatives. High performing specialty, ancillary and in home care network development will also be responsibilities of this leader.

• The focus of the Director of Provider Network Development focus will be to work with providers and payers to expand partnerships and collaboration, leveraging expanded capabilities that support our patients where they live.

Our client's approach to “Care Where You Live” will be supported and communicated through the leadership of this position. This individual serves as a thought leader.

• In partnership with National and local leadership, develop contracting growth strategies across all lines of the managed care portfolio.
• This leader will assist the National SVP of Provider Relations and Contracting to develop and implement a national enterprise level IPA governance structure, as well as new network services, programs, and tools in support of all the organization's local markets, including, but not limited to NYC.
• The position will work closely with various ACO structures, payer leaders, physician groups, regional healthcare systems, and other CINQCARE management teams to achieve the financial goals and strategic priorities identified by the organization's on an annual basis.

Management Service Organization (MSO).

• Develop state-level strategy relative to business development and strategic positioning as it relates to provider and payer strategy. Develop/manage a network team to support deliverables/functions related to such initiatives.
• Work with all clinical leadership to expand access to Centers of Excellence, and community support service.
• Provide strategic thought leadership regarding value-based and contracting initiatives. Collaborate with all clinical and finance leaders to develop/implement strategies to maximize the organization's quality and cost performance related to such initiatives. Champion and communicate these strategies to the provider community and identify practices requiring support in achieving performance targets.
• This role demands a high degree of integrity to influence key stakeholders across the organization.
• Will be responsible for developing a portfolio contracting strategy that will support the growth of the organization with a focus on value-based care.
• Work with key National leadership to define contracting strategies that further the mission, vision, and values of the organization. Negotiate FFS Payer contracts with local payers for Care Medical owned practices.
• Advise the market, finance and system leaders on emerging market trends and competitor traction.
• Capable of assisting with the development of innovative risk sharing arrangements that increase opportunities for revenue growth and aligned incentives for appropriate management of the total cost of care.
• Assist SVP in developing and recommending strategic contract initiatives, desirable reimbursement methodologies and other arrangements that drive incremental volume, profitability, and value.
• Support SVP Provider Relations and Contracting with the organization's provider events, workgroups, enterprise provider initiatives, presentations, provider contracts, including language reviews, etc.
• Develop market level contracting strategies and alignment with finance and other operational areas of the organization.
• Perform other job-related duties as assigned.
• Develop pricing methodologies in support of new programs or clinical business planning (e.g. Bundles, centers of excellence, etc.).

General Duties

The Director of Provider Network Development will have the following duties:

• Knowledge: The Director of Provider Network Development will provide subject matter expertise in Network solutions, including determining and recommended approaches for developing and advancing a coordinated approach for solution deployment, and performance evaluation.
• Collaboration: The Director of Provider Network Development will ensure that the organization's capabilities form a cohesive offering, including by working closely with other business divisions to learn their needs, internalize their knowledge, and define solutions to achieve all business objectives.
• Leadership: The Network Lead will lead in defining and executing strategies and solutions to create business value for state wide organization, including building a team to design, develop, and execute those strategies and solutions to deliver desired outcomes.
• Strategy: The Network Lead will establish the business strategy and roadmap: (1) improve outcomes for the organization's members; (2) enhance the efficacy of other business divisions; and (3) develop and deliver external market opportunities enterprise wide, In establishing the business strategy, the Network Lead will define and innovate sustainable revenue models to drive profitability of the Company.
• Culture: The Director of Provider Network Development is accountable for creating a productive, collaborative, safe and inclusive work environment for their team and as part of the larger Company.

Qualifications

The Director of Provider Network Development should have the following qualifications:

• Education: Preferably a Master’s Degree in Business Administration (MBA), Health

Administration (MHA); or equivalent education/experience such as bachelor’s degree in

healthcare administration, finance, business, or related filed, with a record of strong academic achievement.

Experience:

• Ideal candidates will have a minimum of 10 years in leadership position-management of field-based teams and experience contracting across a portfolio of products that include government programs.
• Extensive experience leading high profile contract negotiations, business planning and strategic execution of initiatives.
• A solid understanding of the financial arrangements of facilities, health plan, and medical group in a capitated and non-capitated environment is required.
• Entrepreneurial: our client seeks to fix gaps that have persisted for generations in the delivery of care to the Black and Brown populations. This position is accountable for ensuring we are positioned to innovatively deliver on its promise.
• Relationships: Ability to develop a strong and effectively manage relationships with business leaders, external constituents, and develop strong, trusting external relationships with payers. Ability to gain confidence and trust of leadership across the organization.
• Creative, innovative thinker bringing new ideas and solutions to internal strategy discussions and contract negotiations.
• Solid understanding of both fee-for-service and at-risk payer contracts. Current knowledge of the changing health care landscape at the national and state level.
• Culture: Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial Company.
• Communication: Excellent verbal, written communication, and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to all team members, investors, partners, and other stakeholders.
• At least 10 years in development of contracting strategy at a health system or health plan.
• Ability to work collaboratively and credibly across senior leadership both at the local and national levels.
• Strong working knowledge of health care contract language and negotiation strategies.
• Thorough knowledge of laws and regulations relating to managed care and other payer functions.

Job Type: Full-time

Salary:

$140,000.00 - $165,000.00 per year

Benefits:

• Paid time off
• Parental leave
• Flexible schedule
• 401(k) matching
• Retirement plan
• Life insurance
• Dental insurance
• Health insurance
• Flexible spending account
• 401(k)
• Vision insurance

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Georgia: Reliably commute or planning to relocate before starting work (Required)

Willingness to travel:

• 35% (Required)

Work Location: In person

Equal Opportunity Employer