VP, Population Health Contracting and Network at Prospect Medical Holdings, Inc. in Johnston, Rhode Island

Job Description:

The Vice President of Population Health, Network and Contract Management is responsible for the oversight of value-based contracting and their implementation and related activities for CharterCARE (RI) under the direction of the SVP Prospect Medical, RI. The position is a hybrid role, with travel required to Providence, RI.\n Prospect Medical Holdings' ability to deliver quality, compassionate care during the unprecedented pandemic affirms the original vision of its founders. This is the fulfillment of the hopes Prospect's founders had for the company, and proof that a clear vision, an insightful operating model, and a commitment to communities and our employees, born in the past, remains the way of the future.\n
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\n Every day, our more than 11,000 affiliated physicians and 18,000 employees at 17 hospitals, 165 outpatient centers and 28 medical groups provide nationally recognized care in six states. Our comprehensive network of quality healthcare services is designed to offer our patients and 600,000 members highly coordinated, personalized care tailored to the unique needs of each community we serve-many of which provide essential medical services to underserved communities as safety-net hospitals.\n
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\n The compensation of the successful applicant will be determined at the time of the offer. In determining the compensation offered to an applicant, the Hiring Manager considers many factors including but not limited to, the candidate's relevant work experience, education, certifications and licensure, internal peer equity, local market, as well as organizational considerations.\nEducation/Experience Bachelor's degree in Business Administration, Healthcare Administration or related field. MBA or MHA degree preferred. 10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
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Qualifications:
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• Excellent written and verbal communication skills required.
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• Extensive knowledge, experience and expertise in managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, physicians and ancillary providers, shared shavings and risk contracting, managed care regulations and quality/shared savings program metrics and methodologies.
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• Excellent skills in Microsoft Office Excel (including advanced spreadsheet and formula manipulation), as well as in Word and PowerPoint. Access skills preferred but not required.
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• Demonstrated skills in attention to detail, superior project management, implementation, and analytical ability as well as the ability to coordinate and lead activities using a collaborative and team approach.
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• Ability to handle multiple projects and perform independently under tight deadlines with a focus on effective implementation, clear and consistent communication, and follow-up.
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  Position Purpose Direct the provider network and contracting activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for all quality based contracting and physician agreements.
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• Establish the department's strategic vision, objectives, and policies and procedures.
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• Develop, implement and maintain production and quality standards for Contracting and Network management.
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• Oversee network development staff and external consultants in the development of provider networks across expansion markets.
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• Perform periodic analyses of the provider network from a cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet Company goals.
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• Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts.
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• Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.
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• Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy.
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• Support market expansion and M&A activities by leading provider contract analysis related to due diligence.
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• Oversee fee-for-service and value-based contracting activities for RI, oversight of managed care team, and manage payer contracts and relationships for all network hospitals, physicians, IPA and ancillary providers. Develop payer strategies to ensure an optimal contracting and operational outcome for RI providers, advocating on behalf of the RI providers as issues, opportunities or disputes arise. Negotiate contracts with managed care payers on behalf of RI providers, including rates, payment methodologies, contract language, value based and shared /full risk and capitation payment programs, following all internal controls for contract review, approval and signature and in alignment with RI vision, goals and objectives.
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• Develop processes and manage implementation and ongoing management of completed contracts, including identification and tracking of critical contract and renewal dates, ensuring that proper scanning, recording and filing of contract documents occurs, oversee dissemination and communication of information to internal constituents and education on new /revised terms. Monitor contract performance regarding financial performance, payment integrity, value-based payment programs, compliance with contract terms and key performance indicators. Monitor payer activity with respect to network development, product strategies, payment policies and other relevant market intelligence.
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• Oversee payer relationships with a focus on promoting proactive, professional, and collaborative relationships, problem resolution and avoidance future of issues whenever possible and progression to capitated contracts even before payers would choose to do so.
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• Promote enhanced use of available contract management and analysis tools to support contract negotiations, revenue recovery and contract performance, providing support to decision support, finance and budget on managed care issues.
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• Ensure RI providers and payers comply with all contract provisions, via tracking of performance through a variety of means, including audit of current performance via claims review, reports, etc.
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• Work collaboratively with RI health system and IPA executive leadership and management, operating unit departments and support areas such as patient access, central billing offices and medical management areas to improve functions across departments and with payers.
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• Prepare and provide training, materials, and tools for use by RI providers and their staff regarding key managed care contract provisions, market trends and opportunities for improvement in support of facility goals and objectives, consistent with the mission and values of RI. Proactively communicate and educate RI operational areas regarding contract changes, policy updates, etc., to ensure RI staff have information needed to successfully implement and operationalize agreements.
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• Negotiate contracts with the Medicaid Managed Care Organizations that are beneficial to CharterCARE affiliated providers and the IPA and move payers rapidly and progressively to capitated, delegated contract that are profitable to CharterCARE affiliated providers.
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• Perform other duties as assigned/required by supervisor.
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• Ability to travel.
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• Perform other duties as assigned/required by supervisor.
\n

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• 
  Position Purpose Direct the provider network and contracting activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for all quality based contracting and physician agreements.
\n

\n

\n
• Establish the department's strategic vision, objectives, and policies and procedures.
\n
• Develop, implement and maintain production and quality standards for Contracting and Network management.
\n
• Oversee network development staff and external consultants in the development of provider networks across expansion markets.
\n
• Perform periodic analyses of the provider network from a cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet Company goals.
\n
• Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts.
\n
• Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.
\n
• Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy.
\n
• Support market expansion and M&A activities by leading provider contract analysis related to due diligence.
\n
• Oversee fee-for-service and value-based contracting activities for RI, oversight of managed care team, and manage payer contracts and relationships for all network hospitals, physicians, IPA and ancillary providers. Develop payer strategies to ensure an optimal contracting and operational outcome for RI providers, advocating on behalf of the RI providers as issues, opportunities or disputes arise. Negotiate contracts with managed care payers on behalf of RI providers, including rates, payment methodologies, contract language, value based and shared /full risk and capitation payment programs, following all internal controls for contract review, approval and signature and in alignment with RI vision, goals and objectives.
\n
• Develop processes and manage implementation and ongoing management of completed contracts, including identification and tracking of critical contract and renewal dates, ensuring that proper scanning, recording and filing of contract documents occurs, oversee dissemination and communication of information to internal constituents and education on new /revised terms. Monitor contract performance regarding financial performance, payment integrity, value-based payment programs, compliance with contract terms and key performance indicators. Monitor payer activity with respect to network development, product strategies, payment policies and other relevant market intelligence.
\n
• Oversee payer relationships with a focus on promoting proactive, professional, and collaborative relationships, problem resolution and avoidance future of issues whenever possible and progression to capitated contracts even before payers would choose to do so.
\n
• Promote enhanced use of available contract management and analysis tools to support contract negotiations, revenue recovery and contract performance, providing support to decision support, finance and budget on managed care issues.
\n
• Ensure RI providers and payers comply with all contract provisions, via tracking of performance through a variety of means, including audit of current performance via claims review, reports, etc.
\n
• Work collaboratively with RI health system and IPA executive leadership and management, operating unit departments and support areas such as patient access, central billing offices and medical management areas to improve functions across departments and with payers.
\n
• Prepare and provide training, materials, and tools for use by RI providers and their staff regarding key managed care contract provisions, market trends and opportunities for improvement in support of facility goals and objectives, consistent with the mission and values of RI. Proactively communicate and educate RI operational areas regarding contract changes, policy updates, etc., to ensure RI staff have information needed to successfully implement and operationalize agreements.
\n
• Negotiate contracts with the Medicaid Managed Care Organizations that are beneficial to CharterCARE affiliated providers and the IPA and move payers rapidly and progressively to capitated, delegated contract that are profitable to CharterCARE affiliated providers.
\n
• Perform other duties as assigned/required by supervisor.
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• Ability to travel.
\n
• Perform other duties as assigned/required by supervisor.
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