Director of Contracting – Value Based and Affiliated Networks

Director of Contracting – Value Based and Affiliated Networks Join to apply for the Director of Contracting – Value Based and Affiliated Networks role at Priority Health Job Summary Directs and monitors the overall performance of provider network development and contract administration. Accountable for the production and implementation of accurate, timely and competitive contacts that reflect all applicable legislative and competitive standards. Develops and assists in the development of network contracting strategies on reimbursement, risk and incentive programs. Directs and is involved in service area expansion activities, including developing strategies for and negotiation with new provider networks. Internally, must work directly with strategic leaders of the company to ensure strategic support for expansion efforts and ability to administer contract arrangements. Externally, engages with health care organizations, CFO's and Director of Contracting to negotiate and finalize contracted arrangements. Works directly with or coordinates all matrix functions (e.g. Operations, Marketing, Utilization Management, Quality Management and Information Services) critical to Network Development. Essential Functions Directs the requisite provider contracting and network development activities within his/her assigned region, through the management of provider contracting teams; such management includes talent selection, development and performance evaluations. Develops and assists with the development of strategic initiatives relating to provider networks, including service area expansions, new payment and incentive methods, risk arrangements and new products. Sustains a successful team among Provider Contract Administrators to facilitate information sharing, optimal use of each PCA's strengths, background and experience to continuously improve provider contracting initiatives. Develop and maintain a comprehensive provider network (hospitals, physicians, ancillary) to deliver a full range of health care services to Priority Health members through recruitment, negotiation, contracting and re-contracting of providers to ensure quality, cost effectiveness and their participation in all products. Lead contracting efforts for new products and new service areas. Analyze, plan and assure provider network adequately meets access needs across all geographic areas. Develop and implement strategies for physician and hospital reimbursement. Communicate internally and externally regarding all provider related issues. Participate on key interdepartmental committees throughout the organization. Analyze, plan and assure provider network adequately meets access needs across all geographic areas for all lines of business and oversee the submission process. Develops strategic initiatives relating to value based and affiliated networks including necessary contract template revisions. Collaborate with Actuary team to set annual value-based targets and to assure that value-based arrangements are within budget and pricing limits. Lead contracting efforts and support for value based as well as affiliated networks. Qualifications Required Bachelor's Degree or equivalent Preferred Master's Degree or equivalent 5 years of relevant experience in managed care with an emphasis on provider contracting, payment methodologies and new market development Physical Demands Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs Waist to Waist > 5 lbs: Seldom up to 10 lbs Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs Waist to Overhead > 5 lbs: Seldom up to 10 lbs Bilateral Carry > 5 lbs: Seldom up to 10 lbs Unilateral Carry > 5 lbs: Seldom up to 10 lbs Pushing Force > 5 lbs: Seldom up to 10 lbs Pulling Force > 5 lbs: Seldom up to 10 lbs Sitting: Frequently Standing: Occasionally Walking: Occasionally Forward Bend - Standing: Seldom Forward Bend - Sitting: Occasionally Trunk Rotation - Standing: Seldom Trunk Rotation - Sitting: Occasionally Reach - Above Shoulder: Seldom Reach - at Shoulder or Below: Seldom Handling: Occasionally Forceful Grip > 5 lbs: Seldom Forceful Pinch > 2 lbs: Seldom Finger/Hand Dexterity: Frequently How Corewell Health cares for you Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. On-demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more Optional identity theft protection, home and auto insurance, pet insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status Primary Location SITE - Priority Health - 1239 E Beltline - Grand Rapids Department Name PH - Provider Network Employment Type Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8-5 Days Worked M-F Weekend Frequency N/A Equal Employment Opportunity Statement Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug‑free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on‑site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. You may request assistance in completing the application process by calling 616.486.7447. #J-18808-Ljbffr