Job Summary:
The Associate Vice President, Provider Contracting, Network and Relations informs decision-making around payer and provider best practices related to innovating, supporting and empowering providers in the pursuit of delivering person-centered and high-quality care to members. Oversees CareSource’s strategic design, implementation, and evaluation of provider contracting, network and relations to proactively support provider engagement and operational performance.
Essential Functions:
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Lead Ohio Department of Medicaid (ODM) contractual requirements, such Network Development Management Plan (NDMP), Network adequacy, Provider Engagement and Education.
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Oversight of Provider’s operational strategy for Ohio. Ensure evaluation and outcomes and alignment across senior leaders to ensure Provider contracting, network and relations are measurable and part of an overall cohesive data informed strategy that ensures overall quality, financial and compliance with State and Federal requirements.
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Oversee collaboration with market and enterprise workgroups to ensure alignment and overall implementation of Ohio strategy, including committees such as Provider Advisory Committee, NDMP Committee, Enterprise Provider Reimbursement Committee, MCA Committee, and others as needed to support the Ohio Provider Network.
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Represent Ohio Market Leadership as panelist and subject matter expert
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Collaborate with the Ohio Executive team to ensure provider contracting and engagement performance related to CareSource enterprise and Market strategies, contractual, policy, and state/federal programs.
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Build, maintain and improve all structure and processes necessary to assure impeccable regulatory record, achievement of goals and consistency from market-to-market and product-to-product.
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Collaborate, innovate and support provider approaches to address contract compliance, industry supported contract requirements and financial alignment.
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Coordinate and collaborate with providers, local and state government, community-based organizations, Ohio Department of Medicaid (ODM), and other ODM-contracted managed care entities to support a strong provider network.
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Ensure that efforts addressed at improving provider engagement, satisfaction and contractual performance are designed collaboratively with other ODM and ODM contracted managed care entities to have a collective impact for the population and that lessons learned are incorporated into future decision-making.
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Collaborate with Enterprise and Market leadership on the development of overall program strategy and business objectives with respect to Providers.
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Foster external and internal intra/inter departmental relationships with hospitals, physicians, community agencies, trade associations and key vendors
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Collaborate with Provider Relations and Community Stakeholders to facilitate access, address barriers to care and improve coordination that support health care outcomes.
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Develop health plan Network policies, procedures and goals as needed to align with the market requirements and CareSource strategy/model
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Ensure budget and financial goals are set in conjunction with the Ohio Market executive team.
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Monitor health plan Network budgets; describe variance detail monthly with effective action plans.
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In collaboration with Consumer Experience Team, monitor and analyze member satisfaction surveys to identify and develop appropriate action plans with reporting activities as needed.
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Produce team results that demonstrate engagement rates, low Grievances & Appeals, Continuous Improvement, Human Capital metrics that demonstrate leadership behavior is supporting improved outcomes, positive culture and consumer experience.
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Develop and maintain an in-depth knowledge of the company’s business, regulatory environments and high-level of Health plan knowledge.
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Consults across Markets to engage in collaborative improvement activities including program planning, analytic review, and communication.
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Perform any other job duties as requested.
Education and Experience:
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Bachelor of Science/Arts Degree or equivalent years of relevant work experience is required.
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Master’s degree in business or health care preferred
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A minimum of ten (10) years of experience in health care external stakeholder and community program support, project and program management; complex business processes, strategic and business planning or related is required.
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A minimum of three (3) years of prior management experience is required
Competencies, Knowledge and Skills:
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Proficient in Microsoft Excel, Word, PowerPoint and Excel
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Critical listening and systematic thinking skills
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Planning, problem identification and resolution skills
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Business process/management skills
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Strong financial background
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Ability to maintain confidentiality and act in the company’s best interest
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Strong oral, written, and interpersonal communication skills
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Excellent leadership, management and supervisory skills and experience
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Energetic, enthusiastic, and politically astute
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Ability to act with diplomacy and sensitivity to cultural diversity
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Responsive to a changing environment
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Strategic deployment and management skills
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Conflict resolution skills
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Knowledge of regulatory reporting and compliance requirements
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Proficiency with provider engagement, performance improvement and operations
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Ability to work with multi-disciplinary departments across the organization
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Demonstrated ability to develop, prioritize and accomplish goals
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Strong interpersonal skills and high level of professionalism
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Ability to work independently and within a team environment
Licensure and Certification:
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Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated
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To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
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CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
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General office environment; maybe required to sit/stand for long periods of time
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Travel may be required to travel 25% to 50% of the time to perform work duties; a valid driver’s license, car and automobile insurance are necessary for work-related travel
Compensation range $150,000-$300,000. CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Energize and Inspire the Organization
Influence Others
Pursue Personal Excellence
Understand the Business
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