Vice President, Provider Networks
Posted on: 27 Jun 2021
Rancho Cordova, CA
Job Description
Position Purpose:
The Vice President, Provider Network Management (Federal Services) is accountable for the strategic direction, performance results, and the development and management of provider networks to support multiple large-scale federal government programs. The role will lead all aspects of outcomes based network growth strategy including, but not limited to a national contracting strategy, innovative value based contracts, and risk sharing models.
Develop provider network strategies that support multiple large scale government programs. Lead the development of network strategies and reimbursement models to align incentives with provider performance.
Manage the strategic development of national and regional networks that support program specific performance standards and business goals. Accountable for ensuring network composition includes appropriate distribution of provider specialties to achieve network adequacy requirements.
Drive cost effective strategies including the management and negotiation of value based contracts. Conduct regular review of contracting rates to ensure cost strategy is on target
Responsible for the overall performance including network effectiveness, cost containment, quality outcomes and provider satisfaction and engagement. Drive critical network development initiatives or analysis requiring collaboration with other functional areas including but not limited to medical management, data analytics, finance, or other program management.
Develop and deliver comprehensive and value-add education and communication to provider partners and internal stakeholders to effectively execute strategic objectives.
Assess and develop a plan to address existing technology enablers to identify gaps and opportunities to develop approaches toward improving the overall delivery system
Education/Experience:
Bachelor’s degree in Business Administration, Healthcare Administration, or related field required; MBA preferred.
10+ years’ experience in managed care network development and provider relations/contracting strategy, negotiation and management in a large healthcare and/or managed care environment required. 3+ years of management experience required. Ability to think strategically and drive complex strategies in an ambiguous and evolving healthcare environment; strong influencing and negotiation skills; leader with experience transforming a team in a dynamic health care environment preferred.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
