PLEASE VISIT OUR CAREER SITE TO OFFICIALLY APPLY
The Director, Provider Contracting is accountable for all phases of planning and execution of strategies designed to produce the highest level of performance by the Provider Network in support of the enterprise-wide WPMG Business Plan. The position directs the Provider Contracting staff for the execution of strategic and tactical plans consistent with health plan and delivery system objectives across Washington State and Northern Idaho. The Director will lead and direct committees and cross divisional workgroups regarding, but not limited to financial modeling, quality performance, cost reduction, and network access determinations. The position will build and manage key internal and external relationships, in collaboration with health plan and group practice leadership. Responsible for executive level communications (verbal, written, presentations) and reporting on network performance and directing team execution of network optimization initiatives. The Director represents WPMG at outside activities/meetings and is the subject matter expert on provider contracting, performs strategic planning, policy development and professional staff oversight and development. Develop and maintain integrated work processes to support the provider network. Accountable for ensuring WPMG is positioned to achieve cost, quality targets and a competitive advantage in the marketplace. Assemble, direct, and lead negotiating and oversight teams for WPMG’s most complex multi-million-dollar contracts, which includes relationship building and strategic oversight. Lead and mentor teams of professional contracting staff through oversight of policies and processes. All these accountabilities will be accomplished while ensuring compliance with all state and federal regulatory requirements and KFHPWA and WPMG policies.
Provide leadership and direction in developing short and long-term strategies for Provider Contracting and Network
Development, including establishment of vision, policy and operational processes in support of departmental, divisional and enterprise-wide objectives.
Build and manage internal and external relationships. Provides direct linkages between inter-company and community providers and vendors. Coordinates departmental strategy & policy development with executive leadership.
Evaluates and determines key contracting methodologies to be utilized to provide best in class unit price and operational goals/targets. Integrates contracting strategy with regional/district budgets, finance & rate setting, marketing, health plan operations, payment policy and care management. Establishes relationships involving a broad spectrum of community & national healthcare professionals through presentations, meetings, conferences and associations.
Lead contract strategic development.
Provides high-level consultative & technical expertise to delivery system leadership, marketing, planning, product development committees and other key policy development forums. Responsible for developing and providing key
information to be shared with internal and external stakeholders through a variety of formats. Advises & directs in planning, resource allocation and implementation of policy & process changes. Identifies business system, quality improvement and performance reporting requirements.
Leads Provider Contracting Department. Develops and oversee departmental budget, operations and policies.
Directs a team of professionals to achieve contracting objectives. Assures development & implementation of effective policies & systems related to provider network performance (contracting, unit cost targets, network adequacy, payment, dispute resolution, reporting and regulatory compliance). Establish contract and payment methodologies/policies and assures compliance.
Monitor financial performance and provide strategic direction and oversight related to budgetary development, project plans and implementation schedules to meet divisional goals.
Participate on division senior leadership team and communicate strategic direction to and decisions to appropriate audiences.
Establishes, reviews & approves management work plans detailing objectives, budget impacts and strategies by division, service line, or department. Budget and provider reimbursement increases/decreases are determined as part of the overall budget. Reviews, approves, and signs provider contracts & third party provider agreements on behalf of the organization. Assess and inform the organization on national and local trends in contracting, payment policy and network design.
Other duties as assigned.
Job Type: Full-time
- Healthcare contracting negotiations: 5 years (Required)
- sales: 1 year (Required)
- Direct supervision of Provider Contract Managers: 2 years (Required)
- Healthcare: 7 years (Required)
- Driver's License (Required)
- Health insurance
- Dental insurance
- Vision insurance
- Retirement plan
- Paid time off
- Temporarily due to COVID-19