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Senior Vice President of Provider Relations

2 months ago

Rancho Cucamonga, California, United States ASSOCIATION FOR COMMUNITY AFFILIATED PLANS Full time


Inland Empire Health Plan (IEHP) is dedicated to healing and inspiring the human spirit, recognized as one of the largest Medicaid health plans and the foremost not-for-profit Medicare-Medicaid plan in the nation.

Celebrating its 26th year, IEHP serves nearly 1.6 million members enrolled in Medicaid, supported by a robust network of over 7,800 providers and a dedicated team of nearly 4,000 employees.

Through strategic partnerships, award-winning service, and a commitment to quality care, IEHP remains steadfast in its Mission, Vision, and Values.

IEHP has consistently achieved exceptional employee engagement scores and has been honored with the designation of 'Great Place to Work' for multiple consecutive years. Furthermore, IEHP proudly holds NCQA Health Equity Accreditation.


Position Overview:


The Senior Vice President of Provider Relations, reporting to the Vice President of Provider Experience, collaborates closely with Finance and Actuarial Services to oversee the comprehensive development and management of contracting strategies, compliance, and provider-focused projects, initiatives, and data analysis.


Key Responsibilities:
  • Provide strategic guidance and oversight for Provider Contracting and Strategic Relationships.
  • Collaborate with the Provider Network team to ensure network adequacy in compliance with regulatory requirements and organizational strategies.
  • Develop and execute both short-term tactical initiatives and long-term strategic plans.
  • Integrate provider network activities, programs, policies, and initiatives across the organization.
  • Demonstrate insight, innovation, and leadership to manage multiple strategies effectively, ensuring the management of medical benefit costs while enhancing quality, access, and member satisfaction.

The ideal candidate will possess extensive experience in Medi-Cal contracting and a solid understanding of California regulatory requirements and compliance. Familiarity with Medicare and Commercial plans is advantageous.

Strong strategic and communication skills are essential for success in this role, along with the ability to collaborate effectively across departments.

The Senior Vice President must excel in a highly collaborative, mission-driven culture and possess the ability to foster and maintain robust external relationships.


Team Structure:
This role includes three direct reports, overseeing a total staff of approximately 12.

Core Duties:


Lead the strategic direction and daily operations of Plan Management and Provider Contracting Services to support organizational initiatives.

Plan, develop, direct, and coordinate managed care policies, goals, and objectives related to provider contracts, negotiation strategies, and execution across all product lines, including Medi-Cal and Medicare.

Prepare and negotiate contracts in collaboration with the Vice President of Provider Experience and the Vice President of Actuarial Services to ensure contractual obligations are met and financial performance standards are upheld.

Oversee financial and operational evaluations of contracted entities, developing corrective action plans as necessary.

Implement initiatives to control medical costs, aiming to achieve budgeted targets.

Support innovative provider contracts that incorporate performance accountability and effective medical management strategies.

Lead the provider contracting team and collaborate with Health Services to identify and recruit providers based on network needs.

Enhance servicing activities for business expansion in both new and existing geographic areas.

Work with the Provider Relations team to strengthen and develop new relationships with physicians, specialists, and ancillary providers.

Incorporate innovative quality and cost control programs to enhance care delivery for members.

Provide leadership and accountability for the operational effectiveness of the Provider Contracting department, aligning annual work plans with organizational priorities.


Experience Requirements:


A minimum of seven years of relevant experience in contract execution, negotiation, and leadership within a managed care environment at a senior leadership level.

Comprehensive understanding of managed care, including Medi-Cal and Medicare.

Experience collaborating effectively with healthcare providers, with a preference for integrated delivery systems.

Demonstrated experience in leading provider network activities, including network development and value-based contracting strategies.


Educational Background:
A Bachelor's degree in a related field is required; a Master's degree is strongly preferred.

Compensation:
A competitive salary range is established based on relevant experience and internal equity considerations.

Additional Responsibilities:


Foster positive working relationships at all organizational levels to ensure collaboration in identifying and prioritizing impacts of Provider Contracting initiatives.

Maintain positive relationships with provider partners and ensure regulatory documentation accuracy.

Participate in audits and engage with regulatory agencies as a respected leader.

Ensure compliance with privacy and security regulations regarding Protected Health Information (PHI).


Essential Skills and Attributes:


Demonstrated financial acumen and the ability to utilize data for informed decision-making in contracting and medical management.

Understanding of financial implications while ensuring compliance with legal and regulatory standards.

Ability to navigate a complex, rapidly evolving environment, demonstrating high-level initiative and judgment.

Proven track record in building and mentoring high-performing teams and fostering successful relationships across various contexts.

Capacity to work independently and collaboratively within a team-oriented environment to achieve results.