job

About the Organization:

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. In its 26th year, IEHP supports nearly 1.6 million members who are enrolled in Medicaid and has a growing network of over 7,800 providers and nearly 4,000 Team Members (Employees). Through dynamic partnerships, award-winning service, and a tradition of quality care, IEHP is fully committed to its Mission, Vision, and Values.

IEHP has consistently achieved outstanding employee engagement scores from their nearly 4,000 Team Members and was most recently recognized and awarded the designation of ‘Great Place to Work’ for a third year in a row! In addition, IEHP is proud to announce the team recently earned NCQA Health Equity Accreditation. For details regarding IEHP, please visit: iehp.org.

About the Position:

The Vice President, Contracting, under the direction of the Vice President, Provider Experience and in close partnership with Finance and Actuarial Services, is responsible for the overall development and management of contracting strategies, 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.

The successful candidate will have strong Medi-Cal contracting experience and knowledge of CA regulatory requirements and compliance. Exposure to Medicare and Commercial is a plus. Strong strategic and communications skills are critical to the success of this role as well as the ability to work effectively across departments. The Vice President must thrive in a highly collaborative, mission driven culture and have the ability to build and maintain strong external relationships.

Staff: Three direct reports; total staff is approximately 12.

Duties & Responsibilities:

• Lead the strategic direction and day-to-day functions in Plan Management and Provider Contracting and Services strategies to support Plan operations and initiatives.
• Plan, develop, direct, and coordinate the managed care policies, goals, and objectives related to Provider contract/ amendment language and rate pricing, negotiation strategy, planning, and execution for all product lines, including but not limited to Medi-Cal, Medicare, and the California Health Benefit Exchange.
• Prepare and negotiate all contracts in collaboration with the Vice President, Provider Experience and Vice President, Actuarial Services to ensure the terms of the contracts are fulfilled and health plan economics are maintained including contractual financial performance standards.
• Oversee financial and operational reviews of contracted entities. 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 Experience and Health Services teams to identify and recruit providers based on network composition and needs. Work with the Provider Network 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, specialty, ancillary, 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.
• Provide direct leadership, oversight, and accountability for the operational effectiveness of the Provider Contracting department through the development of an annual workplan that aligns with the organizational priorities which includes infrastructure projects, training & development plans, and actions focus on continuous process improvement of the team’s culture and engagement. Staff to ensure quality of work meets expectations.

 

Experience Requirements:

• Minimum seven (7) years of 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.
• Understand managed care including Medi-Cal, Medicare, and the California Health Benefit Exchange (Covered CA).
• 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.

 

Education:

• Bachelor’s degree in a related field from an accredited institution required.
• Master’s degree in a related field from an accredited institution strongly preferred.

 

Salary range: A reasonable starting salary expectation is between $246,355 and $344,905, based upon related/relevant experience and internal equity.

Meaningful Interest Points About Rancho Cucamonga:

Rancho Cucamonga has all the amenities and qualities that make for a family-friendly city. The public schools in the city are performing slightly above the national average. In fact, the average test score here is 2% higher than the national average and the student-teacher ratio is 23:1. And in 2018, this city was part of the happiest towns to live in the United States. This is a result of its wellbeing, community and environment, and income and employment. The city continues to excel over the years. For example, in 2020, the national civic league named it one of the Ten All-America cities due to its efforts and improvements in healthcare and wellbeing.

The centralized location of the town is one of the best perks, no matter where you are heading out to! From Rancho Cucamonga, you can get to San Diego in less than two hours, Palms Springs in just slightly above an hour, and Los Angeles in only 45 minutes by car. The town isn’t only close to major cities, but you can easily access beaches and mountains from here.

 

Additional Key Accountabilities:

• Cultivates and maintains positive working relationships at all levels of the organization to ensure positive collaboration to identify, assess, and prioritize upstream and downstream impacts of the Provider Contracting initiatives throughout the organization. Develops and maintains positive relationships with IEHP’s Provider partners.
• Ensures regulatory documentation prepared by the Provider Contracting department is accurate and meets regulatory requirements. Participates in audits and interacts with regulatory agencies as a credible, influential, and respected leader.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.

 

Other Knowledge, Skills, and Abilities:

• 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.
• Strategic influencer who drives agreement through intellect, interpersonal and negotiation skills. Excellent organization, process, and project management skills. Strong organizational skills and attention to detail.
• 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. 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. Work independently and collaboratively within a team environment and matrix management structure to deliver results. Work in a complex, rapidly evolving environment which requires high-level initiative, and judgment necessary to bring resolution to sensitive issues.

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