Involved in the development of and responsible for the implementation of the network development and contracting strategy.
Must continually develop an in depth knowledge of contracting and negotiation principles in order to secure results that achieve the objectives of the network strategy.
Ensures the proper negotiation of all provider contracts.
Oversees the execution of all CIN participation agreements and ensures they are in line with CIN Board expectations.
Responsible to fully understand the network landscape in order to ensure network adequacy and anticipate future needs.
Ensures the proper execution of contracts per their negotiated language and provides any needed clarity related to the contracts intent.
Responsible to ensure contract language is kept up-to-date and relevant codes and information are reflected accurately.
Responsible to successfully manage and execute upon the network adequacy strategies for the provider networks or the specific populations they serve.
Leads in the development of all network adequacy reporting and working closely with internal teams to ensure an efficient process by which information is gathered and reported.
Interfaces with all applicable internal and external stakeholders related to network adequacy including, but not limited to, identified gaps and the strategy to fill those gaps.
Responsible to support multiple CINs and Networks across broad regions with focus on system wide contracting opportunities.
Responsible for supporting the CIN governance structure to ensure actions from the Board are executed upon in a timely and reportable fashion.
Supports applicable CIN committees and the Board by providing network adequacy, capacity, and participation information and developing strategies related to filling gaps and growing the network.
Continuously safeguards the liability exposure through the monitoring of compliance with the relevant policies and procedures, and state and federal requirements as they pertain to network providers.
What You Will Need:
Education and Experience Required:
Bachelor’s degree in health services administration, business or related field, AND/OR
Five years previous contracting experience in a provider network (payer) entit
Knowledge and Skills Required:
Comprehensive understanding of provider contracting.
Strong negotiation skills.
Knowledge of value-based care models.
Extensive experience working with independent providers.
Ability to think independently, exercise reliable judgment and problem solve.
Written and verbal communication skills.
Ability to maintain calm disposition and diffuse confrontational situations.
Ability to react effectively to unplanned circumstances, demands, and challenges.
Ability to function in a fast-paced, high-pressured environment.
Interpersonal skills and ability to relate cooperatively and constructively with customers, co-workers and staff; ability to maintain confidentiality.
Strong computer skills including knowledge of Microsoft Excel, Word, Power Point etc.
Ability to generate management and production reports, documents and correspondence independently.
Ability to maintain a thorough and current knowledge of any applicable networks.
Ability to maintain administrative and management skill supported by interpersonal, as well as excellent verbal and written proficiencies.
This position is responsible for managing the development and execution of the network adequacy strategy, overall network development strategy and the negotiation and contracting of all physician and ancillary (“provider”) contracts. The manager interfaces with all levels of leadership and providers and assists in the transformation of provider arrangements to value-based contracts. In addition, this position is instrumental in identifying providers that align with Triple Aim values
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.