• Director, Contracting and Network Development

    Job Locations US-VA-Richmond
    Job ID
    2018-5098
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Director, Network Development is responsible for setting and implementing the strategy for managing physician contracting (inclusive of value-based purchasing), network adequacy and network development functions.  The incumbent implements the strategy by developing and maintaining provider relationships that result in high-quality, cost-effective and efficient services.

    Responsibilities

    • Lead negotiations for innovative and strategically important provider systems.
    • Develop and implement the strategy for incentive/risk arrangements with input from key stakeholders.
    • Develop and maintain expertise in reimbursement methodologies, analytical tools, and reporting and reconciliation methods to support operational processes.
    • Identify and establish relationships with all large and/or critically important medical providers, integrated provider systems, long-term services and supports, and provider networks.
    • Responsible for ensuring the provider network meets and/or exceeds network adequacy requirements under all lines of business.
    • Develop a Substance Use Disorder (SUD) network in accordance with the state network adequacy requirements.
    • Maintain provider contracts and ensure compliance of contracts with state and federal
    • Assess, prioritize and renegotiate outlier hospital, physician, behavioral health, and ancillary contracts.
    • Collaborate with AVP, Network Development to set strategy for the department and spearhead major initiatives as needed.
    • Attract, train, develop, manage and retain high-performing staff to achieve necessary goals within the organization.
    • Review Third Party Agreements prior to final sign-off.
    • Perform other managerial duties as required.

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelor’s degree in Business Administration, Healthcare Management or related field.

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Minimum of 3 years previous experience in hospital or physician contracting
    • Excellent understanding of healthcare insurance markets the HMO concept and business operations.
    • Demonstrated experience interacting with provider
    • Experience negotiating provider and third party contracts
    • Exceptional organization skills
    • Excellent oral & written communication skills
    • Demonstrated leadership skills.
    • Ability to manage multiple projects while meeting deadlines and achieving business goals.
    • Ability to supervise staff and promote successful performance.

    WORK BACKGROUND/EXPERIENCE

    • 3-5 years demonstrated leadership and experience managing a team

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position
    • Ability and willingness to travel up to 25% throughout the state of Virginia

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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