AVP Health Plan Relationships and Contracting
1 month ago
Location: Washington, DC, United States
Posted on: Nov 20, 2020
Profile
Description: Help grow one of the leading value-based, senior-care providers in the country. Partners in Primary Care and Family Physicians Group (collectively the Care Delivery Organization) are one of the largest and fastest-growing value-based, senior-focused primary care platforms in the country. Operating as a payer-agnostic, wholly owned subsidiary of Humana, Inc., the Care Delivery Organization has more than doubled its footprint in the last two years. Following the creation of a $600M joint venture with Welsh, Carson, Anderson, and Stowe, a leading health care private equity firm, in February 2020, the Care Delivery Organization is on pace to double again in the next few years.
To support that growth, the Care Delivery Organization (CDO) is building out its contracting function. That team is charged with accelerating the Organization's organic growth through execution of a comprehensive contracting strategy. Against that backdrop, the CDO is seeking an experienced healthcare contracting executive for the newly-created position of Associate Vice President, Health Plan Relationships and Contracting, which will oversee the CDO's health plan and other contracted relationships nationally and locally. This role is crucial in ensuring the CDO achieves its goals by securing access to prospective patients and collaboration with payers and other providers to improve quality and cost. With the CDO's rapid expansion, contracting activities continue to grow substantially in volume, financial impact, and complexity. Existing contracts must be continually renegotiated and aggressively managed. This role will manage medical cost through contracting initiatives and analysis of financial reports and trends in the marketplace. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care, primary care, and MSO services. This position reports to the VP, Chief Growth Officer, Care Delivery Organization.
Responsibilities:
- Health plan relationship development and management: Introducing the CDO to local and national leaders of health plans, finding win-win collaboration opportunities and ensuring operationalization of key growth, quality, and efficiency strategies.
- Value-based contracting: Representing the CDO's value proposition to key local and national health plan contracting decision makers, negotiating value-based contracts aligned with the CDO's preferred format, and innovating collaboration with payers.
- Contract Management: Direct leadership and supervision of a team that manages administration of contracts, physician roster management, and claims payment issues.
- Partnering with CDO Markets: Develop joint strategic plan to support market growth with local CDO market leadership teams.
- Fostering Collaboration with External Stakeholders: Establish collaborative forums with local and national health plan leadership teams and key providers.
- Team Management: Develop and direct supervision of a newly-established team of health plan relationship management and contract management professionals.
Key Deliverables (12-18 month horizon):
- Select and implement a contract management system.
- Define the standard operating model for the team.
- Achieving scalability of back office functions.
Key Candidate Qualifications:
- Extensive experience (ideally 7 years) in health care administration, specifically in the payer and/or provider contracting field.
- Demonstrable network of relevant relationships with health plan leaders.
- Proven ability to negotiate risk-based and capitated contracts with health plans.
- Strong collaboration skills with internal and external stakeholders.
- Deep understanding of Medicare reimbursement and value-based contracting models.
- Excellent oral and written communications skills.
- Bachelor's degree in a relevant field is required; Master's degree strongly preferred.
Scheduled Weekly Hours: 40
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