Strategic Network Director

3 days ago

Saint Albans, Vermont, United States CareSource Full time
{"Job Title": "Vice President-Network Strategy", "Job Summary": "

At CareSource, we are seeking a highly skilled and experienced Vice President of Network Strategy to lead our efforts in creating and executing a comprehensive market network strategic plan. This plan will focus on Value Based Purchasing initiatives that differentiate and enable the market to excel, including Pharmacy, Retail, and Behavioral Health initiatives.

", "Key Responsibilities": "
  • Create and execute the Market Network strategic plan, including leading the market with Value Based Purchasing initiatives that differentiate and enable the market to excel.
  • Lead and influence stakeholders, including the Department of Medicaid, Legislators, health partners, and other stakeholders, to create competitive advantages for CareSource and to fully understand the macro models being established or considered in the market and nationally.
  • Meet and exceed projected member access, product, utilization, and budget requirements in all geographic regions pursued by the Plan, leveraging traditional, virtual, and delegated partner providers.
  • Assure that the network(s) meet applicable standards of all Plan products.
  • Design and implement recruitment plans and directly negotiate and coordinate contractual, operational, and service requirements for hospitals, physicians, and ancillary providers.
  • Aggressively seek opportunities to improve the departmental work flows and increase efficiencies.
  • Promote positive relationships with the multitude of network providers.
  • Complete provider surveys periodically to identify opportunities for Plan improvement.
  • Consult with applicable regulatory entities and legal counsel as necessary to address, resolve, or clarify contractual issues.
  • Assure contracts meet all regulatory standards.
  • Comply with the Model Audit Rules (MAR) standards.
  • Ensure the creation and maintenance of policies and procedures as they relate to the management of the department.
  • Ensure compliance with departmental and corporate performance metrics.
  • Maintain a thorough understanding of all provider contract language -- identify and coordinate needed revisions.
  • Maintain integrity of provider data, including multiple enterprise and State systems, as well as written documentation of provider network.
  • Ensure timely on-boarding, including credentialing activities that are compliant with State and accrediting body requirements.
  • Comply with all accreditation standards of URAC and the National Committee for Quality Assurance (NCQA).
  • Lead/manage staff, including recruitment and selection, development, and strategic and tactical management, including excelling at employee engagement.
  • Prepare/meet annual budget to support business plans.
  • Prepare performance, statistical, and other operational reports.
  • Perform any other job-related instructions as requested.
", "Requirements": "
  • Bachelor's degree in a business-related field or equivalent experience is required.
  • Masters' degree is preferred.
  • Minimum of seven (7) years of experience in the healthcare field is required.
  • A minimum of five (5) years of Senior Leadership experience is required.
  • Strong background and experience in all aspects of healthcare, including marketing, network development, finance, and state regulatory guidelines is required.
  • Multi-state provider contracting experience is preferred.
", "Competencies": "
  • Strategic and forward thinking; ability to lead within a matrix organization.
  • Proven ability to negotiate with and develop strong relationships with hospitals and providers.
  • Ability to manage a large, diverse staff.
  • Strong leadership and management skills.
  • Excellent communication skills.
  • Proven People management skills.
  • Ability to work independently and within a team environment.
  • Excellent Attention to detail and follow through.
  • Expertise within healthcare field.
  • Critical listening and thinking skills.
  • Training/teaching skills.
  • Customer service oriented.
  • Decision making/problem solving skills.
  • Collaboration skills.
  • Microsoft Word, PowerPoint, and Excel Proficiency.
", "Licensure and Certification": "

Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.

", "Working Conditions": "

General office environment; may be required to sit or stand for extended periods of time.

", "Compensation Range": "$150,000 - $300,000", "Compensation Type": "Salary", "Competencies": "["Create an Inclusive Environment", "Cultivate Partnerships", "Develop Self and Others", "Drive Execution", "Energize and Inspire the Organization", "Influence Others", "Pursue Personal Excellence", "Understand the Business"]"}

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