The Vice President, Provider Network Management (VP, NM), in concert with and under the direction of the Chief Financial Officer (CMO) will be responsible for providing senior level leadership, guidance and oversight over all network management including: Provider Contracting, Strategic Relationships, Regional Contracting and Plan Management. The position will develop, lead and align the execution of both short term tactical initiatives and long term strategies which will facilitate the organization’s ability to meet or exceed annual medical cost budgets. The VP, NM will provide oversight of major corporate-wide medical and provider oriented projects/initiatives. In partnership with the Chief Financial Officer and the organization’s senior and associate medical directors, the VP, NM will integrate provider network plans, activities, programs, policies and initiatives throughout the company to meet corporate objectives. The VP, NM will exhibit insight, innovation and leadership to drive multiple strategies which will result in effectively managing medical benefit costs while continuously improving quality, access and customer satisfaction.
DIRECT REPORTS: Associate Vice President, Provider Services, Associate Vice President, Provider Contracting, Associate Vice President - Strategic Partnerships and Provider Reimbursement, and Director – Provider Network Management, ASR
In partnership with the Chief Financial Officer, leads the development and implementation of all provider network management strategies and programs.
Leads the functions in Provider Network Management and Provider Contracting.
In partnership with the Chief Financial Officer and medical directors, provides strong leadership in implementing initiatives and strategies to control medical costs to achieve budgeted medical cost targets. This should occur through support of state-of-the-art provider contracts which incorporate the principles of performance accountability, effective medical management strategies, use of health information technology systems and implementation of a process of continuous improvement in care delivery.
Oversees the development and implementation of provider contracting strategies and provider contracting negotiations and ensures the terms of the contracts are fulfilled.
Develops and implements a set of strategies to guide provider contracting and servicing activities for business expansion. Develops and implements strategies to strengthen and/or develop new physician, hospital and other provider relations. Defines provider network expansion requirements in new and existing geographic service areas.
Incorporates new, innovative, emerging and/or effective quality and benefit cost control programs to improve the delivery of high quality and cost effective care for the organization’s membership.
In concert with developing collegial and mutually beneficial relationships, provides insight and information to Henry Ford Health System physician and administrative executives relative to provider contracting activities.
Directs assessment and changes to utilization and medical management business rules and processes in a manner that optimizes the effectiveness and efficiency of network operations and the delivery of clinical care.
Collaborates with Henry Ford Health System (HFHS) leadership on key objectives and system-wide programs. Effectively represents HAP’s interests and relationships with the Henry Ford Medical Group, HFHS provider operations, and other providers of services to HAP members.
In partnership with the Chief Financial Officer, reviews, revises and directs departmental budgets for assigned areas and develops a broad based organizational budget strategy, incorporating both long and short-term corporate objectives. Focuses on cost management initiatives and programs to improve financial performance.
Collaborates with Human Resources to develop and complete an assessment of staff core competencies as part of an effort to attract, retain and develop top talent. Develops an ongoing plan to fill skill gaps, including but not limited to training, cross training, reassigning roles, employee engagement scores, etc. for personal development. Establishes annual employee performance goals and developmental plans for all direct reports and their respective teams. Monitors progress on a quarterly basis to assess the level of employee morale and productivity and developing corrective action plans as indicated.
REPORTS TO: Sr. Vice President, Chief Financial Officer
Education: Minimum Bachelor’s degree in Business Administration, Healthcare Administration or related field with a relevant advanced degree (MHA or MBA) preferred.
At least 10 years of relevant health plan experience; with demonstrated competency in strategy development, negotiations, execution and implementation of contracts.
Minimum five (5) years of relevant management experience.
Demonstrated or equivalent experience in developing and managing networks to support comprehensive health insurance products.
Demonstrated financial acumen and experience using medical cost and other data and information as the basis for making sound decisions in contracting, as well as in the delivery of medical management, quality management and related improvement programs.
Experience working closely and effectively with physicians, hospitals, and other healthcare providers, with a preference for experience in integrated delivery systems.
Proven leader with a demonstrated ability to lead and influence the direction of large scale enterprises.
A strong leader with proven ability to identify the need for change, anticipating, recognizing and creatively addressing resistance to change; working with others to view change as a challenge and opportunity for growth.
Complete understanding of Medical Loss Ratio (MLR) cost drivers and a demonstrated success in managing the medical cost component of the MLR.
10.Demonstrated or equivalent experience in leading all aspects of provider network activities, including network development, provider contracting strategies and negotiations, and provider servicing and relations which will facilitate the creation and maintenance of a high performing, accountable and engaged provider network.
Strategic influencer who drives agreement through intellect, interpersonal and negotiation skills.
Proven ability to attract, build, mentor and direct a high-performing cohesive and well-integrated team.
Understanding of the business environment and community, as well as trends and issues which will, or could potentially, influence the organization’s business performance.
CRITICAL LEADERSHIP COMPETENCIES:
Customer-centric - Looks at problems through the lens of the customer, (both internally and externally), showing empathy and understanding in creating the best solutions.
Commitment to High Reliability - Preoccupation with failure; competence in performance improvement to identify errors for correction while at the same time innovating solutions; messaging to mission; leading safe operations and local learning systems.
Sense of Ownership - Demonstrates accountability for one's own responsibilities. Engages and empowers employees to do the same.
Principled – Self-aware, authentic and trustworthy; demonstrates sincerity and honesty in relationships and a relentless spirit to do the right thing for our customers each and every time.
Innovative – Ability to find creative solutions to challenges; entrepreneurial; navigating ambiguity and uncertainty by pro-actively disrupting traditional thinking when new ideas are needed.
Collaborative – Fosters teamwork across verticals to break down silos; demonstrates excellent communication skills with staff, peers and customers.
Results-Driven – Shows business acumen beyond areas of functional areas of expertise and a bias for action in accomplishing key objectives to help the organization thrive. Even when faced with multiple challenges, demonstrates resilience and swift problem-solving.
Data-based Decision Making – Synthesizes and uses data to improve performance with a focus on safety, customer experience and value.
Change Champion – Shows ease, agility and the ability to influence without formal authority, in driving change necessary to become a highly reliable organization and fulfilling all aspects of our True North framework.
Health Alliance Plan (HAP) is a nonprofit, regional health plan headquartered in Detroit.
Our mission: “to enhance the health and well-being of the lives we touch.”
HAP excels in delivering award-winning disease management, wellness and community outreach programs, and highly personalized customer service.
Henry Ford Health System Alignment:
• HAP is a subsidiary of Henry Ford Health Sys...tem, one of the national’s leading health care systems and a proud recipient of the 2011 Malcolm Baldrige National Quality Award for performance excellence and innovation.
• HAP serves an important role in promoting system integration and care coordination and acts as a catalyst in forming innovative patient care, community, business and economic partnerships. As the voice of the customer, HAP partners with HFHS to improve quality while maintaining a focus on value, affordability and accessibility.
• HAP has more than 1,300 employees in Detroit, Southfield, Flint and Grand Rapids.
• We serve more than 650,000 members through six product lines:
o Group Insured Commercial: PPO, EPO and HMO; Health Engagement programs offer employees incentives to adopt a healthier lifestyle.
o Individual: HAP Personal Alliance PPO, HSA and Short-Term health plans are for individuals and families not covered through employer health insurance.
o Medicare Solutions: HAP Medicare Solutions offer PPO and HMO plans, prescription drug plans, and Medicare Supplement plans for individuals and employer-sponsored retirees.
o Medicaid: HAP Midwest Health Plan has about 10,000 Medicare and Medicaid enrollees.
o Self-Funded: HAP and ASR Health Benefits offer competitive options for Michigan companies and health and welfare funds seeking to self-fund their health benefit costs.
o Network Leasing: Statewide PPO network that can be administered by Third Party Administrators and Welfare Funds