Vice President, Contracting

The Vice President, Contracting, under the direction of the Chief Network Officer (CNO) and in close partnership with Provider Services, is responsible for the overall development and management of IEHP’s Provider network, contracting, compliance and Provider oriented projects, initiatives and data analysis.

This includes:

  • Providing guidance and oversight of Provider Contracting and Strategic Relationships. Working in collaboration with the Provider Network team to ensure network adequacy in geographical areas in compliance with regulatory requirements and IEHP strategies.
  • Developing, leading and aligning the execution of both short-term tactical initiatives and long-term strategies.
  • Integrating Provider network plans, activities, programs, policies and initiatives throughout IEHP.
  • Exemplifying insight, innovation and leadership to drive multiple strategies, resulting in effectively managing medical benefit costs while continuously improving quality, access and Member satisfaction.

Duties and Responsibilities

  • Lead the functions in Plan Management and Provider Contracting and Services strategies to support Plan operations and initiatives.
  • Develop directly contracted PCP network contracting protocols.
  • Prepare and negotiate all contracts in collaboration with the Chief Financial Officer and Chief Network Officer to ensure the terms of the contracts are fulfilled and health plan economics are maintained.
  • Oversee financial and operational reviews of contracted entities. In partnership with the Chief Network Officer, develop corrective action plans including input to claims, audits, policies and procedures, fiscal viability audits and contract compliance issues. Implement initiatives and strategies to control medical costs in order to achieve budgeted medical cost targets. Support 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.
  • Lead provider contracting team and partner with the Provider Network and Utilization Management teams to identify and recruit providers based on network composition and needs. Work with the Provider Relations team to improve servicing activities for business expansion in new and existing geographic service areas. Work in concert with Provider Relations team to develop and implement strategies to strengthen and/or develop new physician, hospital and other Network Providers.
  • Incorporate new, innovative, emerging and/or effective quality and benefit cost control programs to improve the delivery of high quality and cost-effective care for IEHP’s Members.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.

Position Requirements

Education/License:

  • Bachelor’s degree in a related field is required.
  • Master’s degree in a related field is strongly preferred.

Experience:

  • Minimum seven (7) years’ experience of relevant contract execution, negotiation and implementation, network and strategy development, and leadership experience in a managed care setting (HMO, IPA/Medical Group or equivalent) at a Senior Leadership level. Commercial contracting experience is required.
  • Experience working closely and effectively with physicians, hospitals and other healthcare providers, with a preference for experience in integrated delivery systems.
  • Demonstrated or equivalent experience in leading all aspects of provider network activities, including network development, value based 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.

Knowledge:

  • 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.
  • Understanding of the financial implications, while ensuring legal and regulatory compliance.
  • Understanding of Medical Loss Ratio (MLR) cost drivers and a demonstrated success in managing the medical cost component of the MLR.
  • Understanding of the business environment and community, as well as trends and issues which will, or could potentially, influence the organization’s business performance.

Skills and Abilities:

  • 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.
  • 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.
  • Proven track record in building successful relationships in a variety of contexts.
  • Successful execution of innovative and effective ideas and strategies.

Essential Functions

Physical Activities: Travel within California.

Commitment to Team Culture: The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

The position purpose, principal accountabilities, essential functions, minimum qualifications and the requirements listed in this position description are representative only and are not exhaustive of the tasks that a Team Member may be required to perform. IEHP reserves the right to revise this position description at any time and to require Team Members to perform other tasks as circumstances or conditions of its business considerations or work environment change.

Position Description »