Compass Healthcare Consulting & Placement is conducting a search for a growing Managed Care Plan in NYS for a VP of Network Management. Qualified candidates will have previous experience with Network Operations, Network Data, Contracting with Ancillary, Provider & Hospitals, Credentialing and Provider Relations at a VP level. Comfortable overseeing department wide operations and management. NYS Managed Care Plan including MLTC, Medicaid and Medicare Product line experience required. Company is based in Manhattan, NY office. Position is hybrid, must be available to commute in-office on occasion.
The Vice President of Network Management, Development, Data, Contracting and Provider Relations is responsible for recruitment, contracting, and maintenance of provider network for all MLTC, and Medicare/Medicaid lines of business in existing and new markets. Previous experience in Medicaid/Medicare contracting and negotiating hospital and large group contracts including IPAs and FPP.
- Oversees and/or negotiates provider contracts for hospitals, physicians, LHCSAs, SDACs, IPAs, ancillaries, and all provider types for all lines of business.
- Continually evaluates and prioritizes need for network provider growth and works closely with Business Development to identify key providers needed to generate membership growth
- Builds partnerships with key provider groups leading to membership growth and value based initiatives.
- Responsible for maintaining practitioner groups at levels required to meet NYS and CMS requirements.
- Oversees and leads fee schedule implementation process, assuring fee schedules are loaded timely and accurately along with a robust QA process
- Oversees and/or leads review and production of Provider Directories, Provider on-line Search tools, and Provider Manual to meet regulatory and customer needs.
- Assures on-boarding of all new providers
- Conducts and leads large group orientations with IPA, FPP and hospital leadership groups.
- Develops webinars to support ongoing provider education including Model of Care Training, Access & Availability, Fraud, Waste & Abuse etc.
- Oversee Provider Call Center
- Supervises Account Management Staff and internal support team.
- Other projects as required.
- Oversees Credentialing Function for both delegated and directly credentialed providers.
- Accountable for Provider Network submissions to regulatory agencies.
- Accountable for meeting all provider network requirements of regulatory entities.
- Oversees negotiation and implementation of Value Based Payment Agreements.
- Inclusive of coordination with Plan Actuaries, Finance Team, Marketing, Medical Management and all key functional areas of the Plan.
Qualifications:
- Bachelor's degree is required, Master s degree in related field preferred
- 10+ years experience in network management and provider relations with progressively more experience managing large departmental teams.
- Medicaid/Medicare contracting and negotiating hospital and large group contracts including IPAs and faculty plans.
- Value based agreement experience.
Competitive Salary up to $250,000 & Generous Benefits Package
Qualified Candidates Please Apply Now for Immediate Consideration