Director Network Contract & Provider Strategy

Position

Director of Network Contract & Provider Strategy at MedStar Health, District of Columbia.

General Summary

Responsible for the overall direction and management of the contracting value-based care (VBC) and network development strategies for the District of Columbia. Responsibilities include negotiating provider reimbursement rates and contract terms, developing value-based care arrangements, planning, directing, organizing and evaluating the implementation of strategic objectives to ensure access to a quality, cost efficient, comprehensive provider network. Oversight and monitoring of network development and provider contracting. Ensures that cost containment initiatives are met for the health plan. Formulates and implements policies and procedures to ensure compliance with applicable regulatory, contractual and accreditation standards and requirements. Acts as corporate authority on all reimbursement and payment methodologies including incentive and Value-Based Care programs for the District of Columbia and Maryland health plans. Additionally leads activities with other internal departments to provide optimal customer service to network providers and internal customers. Develops and oversees provider education program. Provides management direction, development, problem resolution and leadership for the provider relations team.

Primary Duties and Responsibilities

• Has responsibility for the oversight of network development recruitment contracting and retention activities.
• Develops contract negotiation strategy to meet Strategic Goals.
• Manages Provider Relations department to include day to day operations hiring and performance evaluations. Assists in development and growth in essential job functions and performance standards. Includes development and monitoring of performance metrics and goals for the provider relations team in collaboration with the MedStar Family Choice District of Columbia leadership team. Provides guidance on development performance and productivity. Recommends changes to improve efficiency and effectiveness.
• With guidance develops and expands MedStar Family Choice's Value- Based Care program by partnering with health care systems within DC and Maryland; implement programs and strategies related to manage care contracts.
• Leads develops and implements alternative payment methodologies (shared savings risk sharing bundle arrangements).
• Collaborates with key stakeholders including finance health plan leaders operations and legal to manage financial and operational and legal provisions of the contracts. Implement contracting processes to effectively manage and maintain contract proposal renewals and analysis contract execution and configuration.
• Has knowledge of government programs with a specific focus on Medicaid.
• Assesses market readiness in targeted states for network development and expansion.
• Ensures compliance with state and federal regulatory requirements related to applicable state laws.
• Provides supervision and mentoring of Provider Relations and contracting team.

Minimal Qualifications

Education

Experience

Licenses and Certifications

Knowledge Skills and Abilities

Salary

USD $111,779.00 - $212,513.00 per year.

Seniority level

Not Applicable

Employment type

Contract

Job function

Legal

Industries

Hospitals and Health Care

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