Provider Network Lead- IL

About CINQCARE

CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to Black and Brown communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our Family Members’ race, culture, and environment is critical to delivering improved health outcomes. By empowering Family Members, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care.

About You

The Provider Network Lead should have the following qualifications:

• Education: Preferably a Master’s degree in Business Administration (MBA), Health Administration (MHA); or equivalent education/experience such as bachelor’s degree in healthcare administration, finance, business, or related filed, with a record of strong academic achievement.
• Experience:
  • At least 10 years in development of contracting strategy at a health system or health plan.
  • Ideal candidates will have a minimum of 10 years in leadership position-management of field-based teams and experience contracting across a portfolio of products that include government programs.
  • Strong working knowledge of health care contract language and negotiation strategies.
  • Thorough knowledge of laws and regulations relating to managed care and other payer functions.
  • Solid understanding of both fee-for-service and at-risk payer contracts. Current knowledge of the changing health care landscape at the national and state level.
  • A solid understanding of the financial arrangements of facilities, health plan, and medical group in a capitated and non-capitated environment is required.
  • Extensive experience leading high profile contract negotiations, business planning and strategic execution of initiatives.
  • Creative, innovative thinker bringing new ideas and solutions to internal strategy discussions and contract negotiations.
  • Ability to work collaboratively and credibly across senior leadership both at the local and national levels.
• Entrepreneurial: CINQCARE seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for ensuring CINQCARE is positioned to innovatively deliver on its promise.
• Communication: Excellent verbal, written communication, and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to CINQCARE’s team, investors, partners, and other stakeholders.
• Relationships: Ability to develop a strong and effectively manage relationships with business leaders, external constituents, and develop strong, trusting external relationships with payers. Ability to gain confidence and trust of leadership across the organization.

About the Job

Overview

The Provider Network Lead (IL) reports to the SVP of Illinois Value Based Care Operations, with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQCARE Inc.’s requirements. They should embody CINQCARE’s core values, including being Trusted, Empathetic, Committed, Humble, Creative and Community-Minded.

Primary Responsibilities

• The role of the Provider Network Lead is accountable for developing and leading a coordinated and strategic network development and servicing approach for the CINQCARE Illinois market.
• This leader will oversee CINQCARE Illinois’ recruitment of primary care practices into CINQCARE’s networks (both IPA and ACO REACH). This position oversees and develops the market’s network expansion plans, as well as new product and partnership strategies across the provider and payer portfolio.
• This leader works in partnership with local and national leadership to develop, execute and advise on IPA and ACO REACH network development strategies, PCP practice acquisitions, contracting provider partnership strategies and opportunities for growth/payer pull-through initiatives. The development of high performing specialty, ancillary and in home care networks will also be responsibilities of this leader.
• This Provider Network Lead focus will be to work with providers and payers to expand partnerships and collaboration, leveraging expanded capabilities that support our Family Members where they live. CINQCARE’s approach to “Care Where You Live” will be supported and communicated with and through the leadership of this position. This individual serves as a thought leader.
• The position will work closely with various ACO structures, payer leaders, physician groups, regional healthcare systems, and other CINQCARE management teams to achieve the financial goals and strategic priorities identified by CINQCARE on an annual basis.
• This leader will assist the National SVP of Provider Relations and Contracting to develop and implement a national enterprise level IPA governance structure, as well as new network services, programs, and tools in support of all CINQCARE local markets, including, but not limited to Illinois.
• This role demands a high degree of integrity to influence key stakeholders across the organization.
• Provide strategic thought leadership regarding value-based and contracting initiatives. Collaborate with CINQCARE clinical and finance leaders to develop/implement strategies to maximize CINQCARE’s quality and cost performance related to such initiatives. Champion and communicate these strategies to CINQCARE provider community and identify practices requiring support in achieving performance targets.
• Develop state-level strategy relative to business development and strategic positioning as it relates to provider and payer strategy. Develop/manage a network team to support deliverables/functions related to such initiatives.
• Work with key National leadership to define contracting strategies that further the mission, vision, and values of CINQCARE. Negotiate FFS Payer contracts with local payers for Care Medical owned practices.
• Develop pricing methodologies in support of new programs or clinical business planning (e.g., bundles, centers of excellence, etc.).
• Capable of assisting with the development of innovative risk sharing arrangements that increase opportunities for revenue growth and aligned incentives for appropriate management of the total cost of care.
• Work with CINQCARE clinical leadership to expand access to Centers of Excellence, and community support service.
• Support local market with CINQCARE provider events, workgroups, enterprise provider initiatives, presentations, provider contracts, including language reviews, etc.
• Advise the market, finance and system leaders on emerging market trends and competitor traction.
• Will be responsible for developing a portfolio contracting strategy that will support the growth of the organization with a focus on value-based care.
• Perform other job-related duties as assigned.

General Duties

The Network Lead will have the following duties:

• Leadership: The Network Lead will lead in defining and executing strategies and solutions to create business value for CINQCARE- IL including building a team to design, develop, and execute those strategies and solutions to deliver desired outcomes.
• Strategy: The Network Lead will establish the business strategy and roadmap: (1) improve outcomes for CINQCARE members; (2) enhance the efficacy of other CINQCARE business divisions; and (3) develop and deliver external market opportunities for CINQCARE. In establishing the business strategy, the Network Lead will define and innovate sustainable revenue models to drive profitability of the Company.
• Collaboration: The Network Lead will ensure that CINQCARE capabilities form a cohesive offering, including by working closely with other business divisions to learn their needs, internalize their knowledge, and define solutions to achieve the business objectives of CINQCARE.
• Knowledge: The Network Lead will provide subject matter expertise in Network solutions, including determining and recommended approaches for developing and advancing a coordinated approach for CINQCARE, solution deployment, and performance evaluation.
• Culture: The Network Lead is accountable for creating a productive, collaborative, safe and inclusive work environment for their team and as part of the larger Company.

Qualifications

The Network Lead should have the following qualifications:

• Education: Preferably a Master’s degree in Business Administration (MBA), Health Administration (MHA); or equivalent education/experience such as bachelor’s degree in healthcare administration, finance, business, or related filed, with a record of strong academic achievement.

· Experience:

§ At least 10 years in development of contracting strategy at a health system or health plan.

§ Ideal candidates will have a minimum of 10 years in leadership position-management of field-based teams and experience contracting across a portfolio of products that include government programs.

§ Strong working knowledge of health care contract language and negotiation strategies.

§ Thorough knowledge of laws and regulations relating to managed care and other payer functions.

§ Solid understanding of both fee-for-service and at-risk payer contracts. Current knowledge of the changing health care landscape at the national and state level.

§ A solid understanding of the financial arrangements of facilities, health plan, and medical group in a capitated and non-capitated environment is required.

§ Extensive experience leading high profile contract negotiations, business planning and strategic execution of initiatives.

§ Creative, innovative thinker bringing new ideas and solutions to internal strategy discussions and contract negotiations.

§ Ability to work collaboratively and credibly across senior leadership both at the local and national levels.

• Entrepreneurial: CINQCARE seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for ensuring CINQCARE is positioned to innovatively deliver on its promise.
• Communication: Excellent verbal, written communication, and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to CINQCARE’s team, investors, partners, and other stakeholders.
• Relationships: Ability to develop a strong and effectively manage relationships with business leaders, external constituents, and develop strong, trusting external relationships with payers. Ability to gain confidence and trust of leadership across the organization.
• Culture: Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial Company.

Location: Chicago, IL