Job Description

TITLE: VICE PRESIDENT, PROVIDER NETWORK MANAGEMENT – AZ AND TX LOCATION: REMOTE MARICOPA COUNTY, ARIZONA AND SAN ANTONIO, TEXAS REPORTING TO: SVP, NATIONAL NETWORK MANAGEMENT & MSO OPS

The Vice President, Provider Network Management – AZ is responsible for continued network development and management, while coordinating with local health plans, hospitals, physician practices and community stakeholders.   Achieve an operating budget, quality benchmarks, membership targets and physician development goals, while ensuring quality and satisfying service to members, physicians, and provider partners.

Develops and implements strategic expansion plans, executes revenue-driven initiatives in a highly competitive marketplace and achieves membership growth goals via retention & new growth.  Responsible for ensuring compliance with company and regulatory requirements, mandates, and ACA reform.  Identifies technology and procedure improvements for increased efficiencies, accuracy, and continuous process enhancements.

KEY RESPONSIBILITIES:

• Impacts Prospect’s profitability and market position in assigned region by managing:  strategic membership growth initiatives, medical loss ratio, performance program compliance (HEDIS, P4P, STARS), RAF score improvement, clinical care program participation, encounter data submissions, provider satisfaction, provider Contract strategy and physician rewards / bonus programs.
• Provides direct management and community service and/or leadership, mentoring and management to Network Managers and support staff to advance team members, while developing metrics and tools to measure/effect progress on team goals:  increase revenue and reduce unnecessary expenses; grow membership strategically; build strong relationships with providers and health plans; and achieve quality performance metrics.  Ensures team’s compliance with company policies, procedures and workflows and strategic use of tools and reports.
• Collaborates and markets networks with brokers and health plan career agents to increase membership across targeted product lines.  Identifies and seizes new business opportunities to ensure achievement of revenue-driven objectives.
• Thoughtfully expands contracted provider base, exclusivity or innovative arrangements and niche network opportunities. Ensures tactical region development, specialist panel progression and provider maintenance to attract and retain members.  Maintains effective relationships with providers and nurtures partnerships with health plans, hospitals, and local community resources.
• Organizes and/or conducts effective Joint Operation Committee meetings and/or management review sessions with designated providers and/or groups to further company goals.

REQUIREMENTS:

• Bachelor’s degree required
• Proven success in achieving & surpassing key performance metrics, including membership growth, physician performance and financial targets
• Working knowledge of federal and state legislation related to HMO & IPA entities, including Centers for Medicare/Medicaid, and Department of Health Services.
• Strong written, verbal, and presentation skills.  Ability to effectively present information and respond to questions from senior management, employees, physicians, and patients.
• Ability to shift from a high-level strategic focus regarding initiatives to a detail-oriented task-driven focus as well as working concurrently on a variety of tasks/projects with competing deadlines and turnaround times.
• Ability to motivate and engage staff, building trust and consensus, and appropriately delegating and empowering a high-caliber professional team.
• Strong computer skills, Word, Excel, Access, PowerPoint, and office equipment.
• Must have advanced reasoning and highest level of problem solving and planning skills

PREFERRED REQUIREMENTS:

• Advanced/Master’s degree preferred
• IDX & Power BI experience highly desirable.
• 7+ years of experience in the healthcare industry, preferably with direct physician interaction
• 5+ years of experience with management and metric management in a process and/or service environment

To perform this job successfully, an individual must be able to perform the job description satisfactorily. This job description reflects management's assignment of essential functions, it does not prescribe or restrict the tasks that may be assigned.  The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

The foundation of our culture is based on our Values of: Teamwork, Integrity, Accountability, Innovation, Compassion, Excellence, and Respect. We believe these Values are at the core of who we are as an organization and how we want to go about doing business. These aren’t just words to us, they offer direction and guidance as we strive to provide the highest quality care and service.