Provider Network Management Lead

2 months ago

Chicago, United States LV Staffing Associates Inc Full time
Job DescriptionJob DescriptionOur rapidly growing client located in Chicago IL, is looking to add to staff. We are currently looking for an experienced Provider Network Lead for the office located on La Salle Street. This position would require you to be on site 2 to 3 days per week or on the field doing site visits. This is a hybrid position.  The provider network lead is accountable for providing strategy, judgement, organization and evidenced-based analysis to influence decisions, and directly meet the institutions requirements. The core values that should be embodied are being trusted, empathetic, humble, creative and community-minded.  Primary Responsibilities for the Provider Network Management Lead:
  • The role of Provider Network Lead, is accountable for developing and advancing a coordinated approach for the organizations - Illinois market to recruit and/or acquire primary care practices, develop expansion, new product and partnership strategies across the provider and payer portfolio for Medicare and Medicaid product lines with payers, as a sub-contractor within other networks and directly with Federal and State Governments (ACO REACH).
  • This position works in partnership with local and national leadership to develop, execute and advise on IPA and ACO REACH network development, PCP practice acquisitions, contracting provider partnership strategies and opportunities for growth/payer pull-through initiatives. High performing specialty, ancillary and in home care network development 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 patients where they live. The company approach is  “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 intercompany management teams to achieve the financial goals and strategic priorities identified by the organization 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 organizational local markets, including, but not limited to Illinois. 
  • In partnership with National and local leadership, develop contracting growth strategies across all lines of the managed care portfolio, including organizational Connect unique capabilities as a standalone Management Service Organization (MSO). 
  • 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 organizational clinical and finance leaders to develop/implement strategies to maximize the organizational quality and cost performance related to such initiatives. Champion and communicate these strategies to the organizations 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 the organization. Negotiate FFS Payer contracts with local payers for the Medical owned practices.
  • Develop pricing methodologies in support of new programs or clinical business planning (e.g., bundles, centers of excellence, etc.).
  • Assist SVP in developing and recommending strategic contract initiatives, desirable reimbursement methodologies and other arrangements that drive incremental volume, profitability, and value. 
  • 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. 
  • Develop market level contracting strategies and alignment with finance and other operational areas of the organization. 
  • Work with the clinical leadership team to expand access to Centers of Excellence, and community support service.
  • Support the SVP with organizational 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 DutiesThe Network Lead will have the following duties:
  • The Network Lead will lead in defining and executing strategies and solutions to create business value for the IL marketing including building a team to design, develop, and execute those strategies and solutions to deliver desired outcomes. 
  • The Network Lead will establish the business strategy and roadmap: (1) improve outcomes for members; (2) enhance the efficacy of other business divisions; and (3) develop and deliver external market opportunities for the organization. In establishing the business strategy, the Network Lead will define and innovate sustainable revenue models to drive profitability of the Company. 
  • The Network Lead will provide subject matter expertise in Network solutions, including determining and recommended approaches for developing and advancing a coordinated approach for the organization, solution deployment, and performance evaluation.
  • 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.Salary is based upon experience but the target is $95k-135k plus a complete benefits package.  If you are interested in this Provider Network Management Lead position located in Chicago, and are qualified, please apply  Our client is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable federal, state or local laws. The management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.     

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