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SilverSummit Healthplan · 10 hours ago

Director, Provider Payment Innovation, Provider Network Management

Nevada, United States

Full-time

Hybrid

Mid, Senior Level

$135K/yr - $249K/yr

7+ years exp

SilverSummit Healthplan is transforming the health of communities through innovative payment strategies. The Director of Provider Payment Innovation will design and implement value-based payment contracting strategies, collaborate with various departments, and lead a team to optimize provider network management.

Health CareHealth InsuranceMedical

No H1B

Responsibilities

Leads provider innovation, provider initiatives and network strategy, including network provider pricing and cost optimization, trend analysis and provider network improvement opportunities

Leads the identification, development, work process design and implementation of new network provider innovation models

Research Federal, State and competitor strategies on value-based payments. Attend conferences and other events to ensure the health plan is fully aware of payment innovation efforts on all levels

Develops and implements provider network innovation and optimization standards and guidelines to increase market share, revenue growth, and quality outcomes

Develops, implements and maintains a multi-year strategic roadmap for the health plan's value-based payments strategy

Leads a cross-functional team and work across the health plan to implement targeted initiatives (bundled payments, hospital quality incentives, shared risk redesign)

Works with key stakeholders to understand and translate external strategies and requirements into internal implementation plans

Collaborates with Networks team on payment innovation work and become the health plan's voice on various corporate committees and initiatives related to payment innovation strategy

Oversees new provider innovation projects and program initiatives, including staff allocation, deliverables, milestones, and goals

Identifies best practice and “center of excellence” opportunities and implement best practice approach to new providers through provider education

Community Networks. Working to develop contracting efforts and maintain relationships with Community Based Organizations

Oversee CIP/QIA budgets - follow SOW for CIP investment rules, look at grant process. Should this process retire, this position would be responsible in building a new strategy

Qualification

Provider network strategyValue-based payment contractingProject managementHealthcare experiencePMP CertificationTeam leadershipAnalytical skillsCommunication skillsCollaboration skillsProblem-solving skills