AVP, Network and Contracting

Job description

Job Summary: The Associate Vice President, Network and Contracting is responsible for the planning, execution, and strategic plan to build hospital, provider and ancillary provider contracting, service, and provider data integrity to facilitate optimal member access, successful business growth initiatives and sound plan financial performance. Essential Functions: - Oversee Provider’s Contracting and Network operational strategy for assigned market, ensuring outcomes are measurable and aligned as part of a data informed strategy that ensures overall quality and compliance with State and Federal requirements. - Develops and maintains a market-specific Provider Reimbursement Strategy consistent with Reimbursement Tolerance Parameters (across multiple specialties/geographies); Oversee the development of new reimbursement models and approval process for Health Plan exceptions for all lines of business. - Establish and sustain relationships with regulatory agencies (e.g., Department of Medicaid, CMS, etc.) and other stakeholders to identify and create competitive advantages for CareSource. - Manages strategic positioning for provider contracting, develops networks and identifies and acts...