Overview

Manages the day-to-day activities of network development and contracting for VNS Health Health Plans. Interacts directly with providers for the purpose of contracting. Facilitates the development of contract templates, contract amendments, incentives, processes, policies and procedures for network development and contracting. Ensures quality and compliance with VNS Health Health Plans, state and federal rules and regulations of network development and contracting processes, contract language and network adequacy. Coordinates network development and contracting efforts with health plan and organization strategies and objectives. Develops relationships with provider community to enhance network development and contracting efforts, which includes facilities, faculty physician groups, physicians, and ancillary providers. Ensures the provider network includes an appropriate distribution of provider specialties to meet competitive and regulatory requirements. Works under general supervision.

Compensation:

$98,200.00 - $130,800.00 Annual

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Works directly with facilities, physicians, and ancillary providers for the purpose of contracting and network development.
• Manages provider distribution to Network Development resources. Assists department leadership in ensuring resources are aligned with the strategy developed by Network Development and Contracting leadership. Manages, revises, and oversees processes, policies, and procedures to ensure leads are contacted in a timely manner.
• Ensures provider contracts are returned with a completed credentialing application, unless otherwise directed by health plan leadership.
• Builds and manages facility network relationships for VNS Health Health Plans. Ensures a geographically competitive network with broad access and stable hospitals that produce an affordable and predictable product. Ensures contracts are in compliance with company contract templates, reimbursement structure standards, and other key process controls.
• Develops and oversees processes, policies, and procedures to ensure compliant contracting practices, including advising on and facilitating the development of training and quality audits. Ensures established processes are in compliance with all applicable agency, state and federal rules and regulations.
• Oversees and ensures quality for contracting process by monitoring and auditing activities of internal and external network development resources.
• Negotiates contract terms. Sets clear and acceptable parameters for network development to use when negotiating contracts.
• Establishes relationships with the provider community to enhance network development efforts.
• Collaborates with health plan leadership, staff, and providers to identify opportunities to improve success of network development and contracting efforts and processes.
• Collaborates with provider network, health plan product, and sales leadership regarding provider capacity monitoring, regional needs assessments and identification of potential providers for recruitment into program and deployment of network development resources.
• Facilitates development of provider recruitment strategy and tools including provider contracts, incentives, marketing and communications.
• Maintains knowledge of agency, state and federal compliance requirements. Maintains knowledge about best practices for provider-oriented sales management, network development and contracting. Devises all strategies and tactics in accordance with this knowledge. Notifies network development resources of applicable changes.
• Performs all duties inherent in managerial role. Recommends hiring, salary actions, performance appraisals, promotions, termination and performs orientation/training to facilitate the professional growth and development of assigned staff.
• Participates in special projects and performs other duties as assigned.

Qualifications
Education:
Bachelor's Degree in Health Administration, Business Administration or related discipline or the equivalent work experience required Master's Degree preferred

Work Experience:
Minimum of five years of experience in health care sales and/or delivery systems, which includes contracting and network development required Prior experience in a managerial position preferred Experience working in healthcare sales administration and/or operational programs required Experience working with healthcare providers as customers or clients required Experience in marketing and public relations in a health care or related environment preferred