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Director, Provider Payment Innovation

Location: Clayton, MO
Job Type: Direct Hire
Salary: $120,000.00 - $185,000.00
Degree: Master; Bachelor;
Date: 7/12/2018
Job ID: 02587995
Job Description
Director, Provider Payment Innovation (Provider Network Management)
Fantastic opportunity to join Fortune 100 leading healthcare enterprise experiencing incredible growth and market expansion.


Design, implement and optimize innovative and value-based payment contracting strategies for the health plan to include the development of a broad vision, short and long-term objectives and execution of key business initiatives across all products. Collaborate with multiple functional health plan departments to build out a strategic payment innovation roadmap. Using the newly developed roadmap, lead the implementation of prioritized initiatives in partnership with Provider Network Management, Medical Management, Product, Claims, Sales and Marketing, Finance and Actuarial teams.

Reports to VP Network Development & Contracting
 
  • Leads provider innovation, provider initiatives and network strategy, including network provider pricing and cost optimization, trend analysis and provider network improvement opportunities
  • Leads the identification, development, work process design and implementation of new network provider innovation models
  • Will Research Federal, State and competitor strategies on value-based payments. Attend conferences and other events to ensure Health Net is fully aware of payment innovation efforts on all levels
  • Develops and implements provider network innovation and optimization standards and guidelines to increase market share, revenue growth, and quality outcomes
  • Develops, implements and maintains a multi-year strategic roadmap for Health Net of California’s value-based payments strategy
  • Leads a cross-functional team and work across the health plan to implement targeted value-based contracting initiatives (Pay for Performance, Shared Risk and Reward, Accountable Care Partnerships)
  • Works with Covered Arizona and other key stakeholders to understand and translate external strategies and requirements into internal implementation plans
  • Collaborates with Networks team on payment innovation work and become the Arizona health plan voice on various corporate committees and initiatives related to payment innovation strategy
  • Oversees new provider innovation projects and program initiatives, including staff allocation, deliverables, milestones, and goals
  • Identifies best practice and “center of excellence” opportunities and implement best practice approach to new providers through provider education
Interviewing candidates with the following Education and Requirements
  • Bachelors’ degree in a related field or equivalent experience (Preferably Finance, Accounting, or Mathematics). Master’s degree preferred. 
  • 7+ years of contracting, network development, or provider network strategy, or provider relations or finance experience in a healthcare or managed care environment. 
  • Previous management experience including responsibilities for hiring, training, assigning work and managing the performance of staff. 
  • Experience preferred in developing and executing multiyear roadmaps, evaluating and negotiating various value-based programs. 
Licenses/Certifications: PMP Certification preferred.
 

Kersey & Associates, Inc.
513 Usdasdi Drive Brevard, NC 28712
Phone: 828-966-9030    Fax: 828-966-9032    Email: david@kersey.com