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MetroPlusHealth · 7 hours ago

Vice President of Provider Contracting and Value-Based Partnerships

New York, NY

Full-time

Onsite

Mid, Senior Level

7+ years exp

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. The Vice President of Provider Contracting and Value-Based Partnerships will oversee the management and negotiation of provider contracts, ensuring a cost-efficient and accessible network while collaborating with various departments to develop strategic initiatives.

Financial ServicesHealth CareHealth InsuranceInsuranceLife Insurance

Responsibilities

Negotiate contracts and manage relationships with participating Hospitals, IPAs, Ambulatory Surgery Centers, SUD sites, Behavioral Health Providers, Urgent Care facilities, and Physician Groups and key specialty providers (e.g., Optometry)

Help develop both the short- and long-term network and contracting strategies for the Plan

Manage the Senior Director to ensure end-to-end contracting process, including outreach, recruitment, contract initiation, amendment mailings, and provider non-renewals and terminations

Develop in conjunction with Executive Leadership a comprehensive Value Based Payment strategy with key provider partners

Coordinate with the Director of Credentialing and Credentialing Department

Coordinate with the Director of Provider Data Management, and the Provider Maintenance Department

Coordinate with the Director of Special Investigations Unit and the SIU Department

Negotiate and review all existing and proposed hospital and large provider contracts. Ensure that reimbursement is competitive, and appropriate for the facility, for the product line, and identify cost saving opportunities for MetroPlusHealth

Manage both the Physical and Behavioral Health provider network; ensure adequacy; ensure payment is competitive and meets regulatory guidance

Coordinate MetroPlusHealth’s network development and contracting strategy as MetroPlusHealth expands into new lines of business

Work with Legal to review and modify any negotiated provider contract language changes as necessary and appropriate

Manage an Out-of-Network strategy that addressed high cost out-of-network cases for all lines of business, but primarily for the Commercial and Exchange products

Manage the process for Single Case Agreements and work closely with Legal and Regulatory on Independent Dispute Resolution processes:

Supervise a team of: Senior Director, Director, and Managers and manage the budget for the entire department

Providing support necessary for the development of policies and strategic direction for expansion of a comprehensive network

Work with Finance and Analytics & Reporting Departments on rate development and related activities, specifically as they relate to the evaluation and analyses of reimbursement structures consistent with industry norms and trends and cost containment initiatives

Work with Analytics & Reporting Department and Reimbursement team to address all contract-monitoring activities, specifically as they relate to providers’ compliance with contract terms and conditions

Collaborate with MetroPlusHealth departments in the development and evaluation of proposals for operational improvements and new products and make recommendations as they relate to improved performance and cost effectiveness

Assist Sales and Provider Network Operations Departments in directing and maintaining relationships with providers through education and provider relations efforts, including assistance in Marketing initiatives to promote membership growth

Perform other related functions as required

Qualification

Contract NegotiationManaged Care LeadershipValue-Based Payment StrategyProvider Network ManagementBudget ManagementTrustFunctional/Technical SkillsIntegrityCustomer FocusWritten/Oral Communication

Required

Master's Degree in Business, Health Care Administration, or related field, required

Minimum of 7-10 years senior management experience in Contracting, including a minimum of 5 years managed care contract leadership experience in New York State

Proven ability to achieve organization's missions, goals and objectives or an equivalent combination of education and experience

Integrity and Trust

Customer Focus

Functional/Technical Skills

Written/Oral Communication