VP, Provider Network

Overview:

The VP, Provider Network provides successful senior leadership to Network Operations by supporting corporate goals and initiatives.  Other responsibilities include supporting the operations team with departmental goals and objectives, reporting KPI’s, and strategically evaluating provider access, growth, and utilization. 

Essential Duties and Responsibilities:           

The VP, Provider Network provides successful leadership to Network Operations by supporting corporate goals and initiatives.  Other responsibilities include supporting the operations team with departmental goals and objectives, reporting KPI’s, and strategically evaluating provider access, growth, and utilization. 

Responsibilities (include but are not limited to):

• In conjunction with the Quality Department, maintain departmental compliance with all applicable regulations involving network operations, including, but not limited to:
  • The No Surprises Act,
  • Parity, and
  • The Price Transparency in Coverage Rule.
  • Coordinate the development of a robust, fully credentialed network that:
  • Meets provider/member ratio requirements,
  • Supports cultural diversity,
  • Creates an energized environment promoting a productive, successful team of associates, and
  • Establishing and maintaining rate schedules – how rates are established, maintained, and any appeals
  • Analyze market trends and determine required growth and contracting needs in specific locations
  • Create and Maintain a provider growth funnel including milestones and timing metrics
• Analyze key business performance indicators (KPIs) focusing on strategic and operational improvements. 
• Support Quality Management by analyzing provider complaints and completing any needed corrective actions.
• Acts in conjunction with Clinical, Operations, Claims, and Compliance to advance corporate initiatives, focusing on quality of care and responsiveness to provider concerns.
• Ensure ongoing network development and available contract rate capacity through a commitment to overall network health.
• Provide direction and close guidance in managing ongoing relationships through communication with all Network Operations associates.
• Manage the everyday workings of Network Operations, and training, ensuring compliance with policies and procedures, and providing accurate reporting to executives. 
• Coordinate and manage Network Recruitment in conjunction with Uprise Health marketing media/team.
• Develop and oversee the execution of action plans concerning provider compliance as part of provider performance oversight.
• Manage and negotiate provider network contracts (individual/facilities) to ensure that performance criteria are met and maintained.
• Work to improve Network process efficiencies, workflows and member journey through the provider experience
• Support systems implementation and migration efforts as needed. 
• Define, establish, and implement a tiered network solution of preferred providers
• Organize and facilitate Network Operations Team meetings to provide vital updates and training to Network Operations associates.
• Organize provider training programs as needed, including developing new modules when appropriate.
• Develop auditing tools and oversee audit results, ensuring network data accuracy.
• Develop and implement provider outreach processes.
• Lead the Credentialling Process/Team and Participate in the Credentialing Committee.

Essential Education and Experience:

• Educational Requirements
  1. College degree and minimum Seven (7) years of Leadership experience in health care environment, with advanced knowledge of provider contracting and claims
• Experience
  1. Seven (7) years working in a professional, corporate, or healthcare office environment with a broad clinical knowledge and experience in a leadership capacity especially working to grow and maintain provider networks.
  2. In-depth knowledge of the following
     1. Negotiating contracts
     2. Financial and budgetary requirements
• Medicare (CMS), NCQA, HIPAA and other regulations
• Skills
  1. Proficiency in the use of MS Office Suite, (Word, Excel, etc.)
  2. Excellent demonstrated verbal and written communication skills both with internal and external customers
  3. Excellent leadership skills

Last updated on Aug 19, 2024