Director of Contracting – Value Based and Affiliated Networks

Job Summary

Directs and monitors the overall performance of provider network development and contract administration. Accountable for the production and implementation of accurate timely and competitive contacts that reflect all applicable legislative and competitive standards. Develops and assists in the development of network contracting strategies on reimbursement risk and incentive programs. Directs and is involved in service area expansion activities including developing strategies for and negotiation with new provider networks. Internally must work directly with strategic leaders of the company to ensure strategic support for expansion efforts and ability to administer contract arrangements. Externally engages with health care organizations CFOs and Director of Contracting to negotiate and finalize contracted arrangements. Works directly with or coordinates all matrix functions (e.g. Operations Marketing Utilization Management Quality Management and Information Services) critical to Network Development.

Essential Functions

• Directs the requisite provider contracting and network development activities within his / her assigned region through the management of provider contracting teams; such management includes talent selection development and performance evaluations.
• Develops and assists with the development of strategic initiatives relating to provider networks including service area expansions new payment and incentive methods risk arrangements and new products.
• Sustains a successful team among Provider Contract Administrators to facilitate information sharing optimal use of each PCAs strengths background and experience to continuously improve provider contracting initiatives.
• Develop and maintain a comprehensive provider network (hospitals physicians ancillary) to deliver a full range of health care services to Priority Health members through recruitment negotiation contracting and re-contracting of providers to ensure quality cost effectiveness and their participation in all products.
• Lead contracting efforts for new products and new service areas.
• Analyze plan and assure provider network adequately meets access needs across all geographic areas.
• Develop and implement strategies for physician and hospital reimbursement.
• Communicate internally and externally regarding all provider related issues. Participate on key interdepartmental committees throughout the organization.

Analyze plan and assure provider network adequately meets access needs across all geographic areas for all lines of business and oversee the submission process.

Develops strategic initiatives relating to value based and affiliated networks including necessary contract template revisions.

Collaborate with Actuary team to set annual value-based targets and to assure that value-based arrangements are within budget and pricing limits.

Lead contracting efforts and support for value based as well as affiliated networks .

Qualifications

Physical Demands

5 lbs : Seldom up to 10 lbs

5 lbs : Seldom up to 10 lbs

5 lbs : Seldom up to 10 lbs

5 lbs : Seldom up to 10 lbs

5 lbs : Seldom up to 10 lbs

5 lbs : Seldom up to 10 lbs

5 lbs : Seldom up to 10 lbs

5 lbs : Seldom up to 10 lbs

5 lbs : Seldom

2 lbs : Seldom

How Corewell Health cares for you

Comprehensive benefits package to meet your financial health and work / life balance goals. Learn more here.

On-demand pay program powered by Payactiv

Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

Optional identity theft protection home and auto insurance pet insurance

Traditional and Roth retirement options with service contribution and match savings

Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1239 E Beltline - Grand Rapids

Department Name

PH - Provider Network

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8-5

Days Worked

M-F

Weekend Frequency

N / A

CURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.

Required Experience :

Director

Key Skills

Crisis Management,Marketing,Public Relations,Fundraising,Media Relations,Constant Contact,Strategic Planning,Social Media Management,Team Management,Public Speaking,Wordpress,Writing Skills

Experience : years

Vacancy : 1