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Executive Director - Risk Based Contracting and Da

Position Summary:


The Executive Director is responsible for the successful network program design, compliance with network requirements, network assessment and selection, and program/product implementation. Top priorities include developing medical cost management strategies, creating a business plan for the Provider Data Integrity team and leadership of the Provider Reimbursement and Contracting modeling sub-systems. The position will be heavily involved in the transition to value-based provider agreements, including ACOs, high value narrow networks and other pay-for-performance contract initiatives. The Executive Director will direct the strategy development, network analysis and implementation; obtain data, verify validity of data, and analyze data as required, and analyze network availability and access. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis.



Qualifications:
EDUCATIONAL REQUIREMENTS
Bachelors Related Field

EXPERIENCE REQUIREMENTS
Ten (10) years of experience working with a managed care organization, health insurer, or consultant in a network management/contract management role, such as contracting, provider services, etc. Five (5) years of experience managing staff. Five (5) years of experience in data analysis. Five (5) years of experience with contract negotiation, submission, validation and maintenance.

OTHER REQUIREMENTS
Intermediate to Advance level of proficiency with all facility/ancillary/physician contract reimbursement methodologies. Strong knowledge of business processes that impact facility/ancillary/physician contract loading and auditing. Ability to convey complex or technical information in a manner that others can understand. Excellent communication skills, including ability to communicate effectively with various levels of leadership. Intermediate to advanced proficiency in MS Office (Excel, PowerPoint).


Essential Functions:

•Provide leadership and management of the Contracting team.
•Analyze cost data to identify affordability savings through contract initiatives or other innovative solutions.
•Support transition to value-based/risk-based provider agreements, including high value networks and other pay for performance contracts.
•Conduct financial analysis of contracted performance and medical trends to monitor contracted performance and develop recommendations concerning network expansion or renewal.
•Ensure compliance with state and federal law and contractual obligations and terms.
•Direct negotiation and execution of provider contracts.
•Develop contracting strategy consistent with overall organizational strategy for all lines of business and development of value-based care models and high performing networks of care.
•Collaborate with legal department to resolve contract disputes.
•Collaborate with finance to manage contracted performance of network providers.

Time:  Full time
Salary:  Salary
Category:  Network management

Updated: 4/26/2018 8:53:52 AM