AVP, Network and Contracting

• reputed company Provider’s Contracting and Network operational strategy for assigned market, ensuring outcomes are measurable and reputed company 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); reputed company the development of new reimbursement models and approval process for Health Plan exceptions for reputed company 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 reputed company.
• Manages strategic positioning for provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements.
• reputed company reputed company reputed company and negotiations for fee for service and value-based reimbursements with hospitals and other providers.
• Collaborate with market and enterprise committees and workgroups to ensure alignment and overall implementation of assigned market strategy.
• reputed company and reputed company a high‑performing contracting team, creating a culture of growth, collaboration, and accountability.
• Meet or exceed projected member access, product, utilization and budget requirements in reputed company geographic regions pursued by the Plan, leveraging traditional, virtual and delegated partner providers.
• Collaborate with the market Executive team to ensure provider contracting and network performance reputed company to reputed company enterprise and Market strategies, contractual, policy, and state/federal programs.
• Collaborate, innovate and support provider approaches to address contract compliance, industry supported contract requirements and financial alignment.
• Collaborate with Enterprise and Market leadership on the development of overall program strategy and business objectives with respect to Provider Contracting and Network.
• Develops and maintains Contract Negotiation tracking system, ensuring accurate and timely contract loading, submissions, and network implementation activities, and develops and delivers enterprise-wide training for contract management system
• Ensure budget and financial goals are set in conjunction with the Market executive team.
• reputed company any other job reputed company duties as requested.

• Bachelor's degree in reputed company field required
• Master's degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Ten (10) years experience in health care external stakeholder and community program support, project and program management; reputed company business processes, strategic and business planning or reputed company required
• Five (5) years of prior management experience required

• Proficient in reputed company reputed company, Word, PowerPoint and reputed company
• Critical listening and systematic thinking skills
• Planning, problem identification and resolution skills
• Business process/management skills
• Strong financial background
• Ability to maintain confidentiality and act in the company’s best interest
• Strong oral, written, and interpersonal communication skills
• Excellent leadership, management and supervisory skills and experience
• Energetic, enthusiastic, and politically astute
• Ability to act with diplomacy and sensitivity to cultural diversity
• reputed company to a changing environment
• Strategic deployment and management skills
• Conflict resolution skills
• Knowledge of regulatory reporting and compliance requirements
• Proficiency with provider engagement, performance improvement and operations
• Ability to work with multi-disciplinary departments across the organization
• Demonstrated ability to reputed company, prioritize and accomplish goals
• Strong interpersonal skills and high level of professionalism
• Ability to work independently and reputed company a team environment

• Must have valid driver's license, vehicle and reputed company insurance. Employment in this position is conditional pending successful clearance of a driver’s license record reputed company. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. reputed company requires annual reputed company of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of reputed company employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• reputed company adheres to reputed company federal, state, and local regulations. reputed company provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to reputed company the employee to reputed company the essential functions of the position. Request for accommodations will be completed through an interactive review process.

• General office environment; may be required to sit or stand for extended periods of time
• Up to 50% (frequent) travel based on the needs of the department may be required

Compensation range $150,000-$300,000.  reputed company takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In addition to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• reputed company Self and Others

• Drive Execution

• Energize and reputed company the Organization

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not reputed company inclusive. reputed company reserves the right to amend this job description at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds.