This executive is responsible to determine and execute on the regional hospital and professional contracting and provider relations strategy. The position is responsible for promoting quality and controlling outside medical cost through effective contracting, provider relations and provider data management, his/herself and through others. The position is also responsible for strategy and planning in the development of new product network configurations including dual choice products, tiered networks, TRICARE, and State-driven options. Position requires superb relationship management and contracting skills. This position consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, complying with all applicable regulations, and acting with ethics and integrity.
Essential Responsibilities:
The ED of Network Development and Provider Contracting is responsible for establishing and maintaining the Mid-Atlantic States Region as the leading health plan partner for key hospitals in our service areas. Position is responsible for the strategy and execution of all hospital contracting in the Mid-Atlantic States Region.
This Executive is responsible for the effectiveness of contract negotiations with hospitals and hospital systems to include being the lead negotiator on very complex and high level contract discussions.
Maintains up-to-date competitive information, including: competitors network composition, network reimbursement, provider incentive arrangements, medical and utilization management practices, technology and electronic communication methods used by competitors in support of their network providers, as well as ACO development and hospital system and ancillary services development and diversification.
ED directs the accurate execution and implementation of financial and operational contract terms, conditions and obligations for the Health Plan, MAPMG and the contracted providers. Understands the reimbursement capabilities of the KFHP claims administration department and creates cost-saving provider reimbursement strategies and practices consistent with these capabilities
Position is also responsible for all network provider relationships as well as for advances in performance incentive programs for contracted hospital and network providers that benefit the health and wellbeing of our members. Develops and directs implementation of adequate provider education activities for contracted providers to assure provider satisfaction and dispute resolution.
Directs the analysis and reviews of strategies pertaining to operational needs, new technology, cost implications of internalization of medical services, increasing costs associated with non-contracted or under-contracted services, unsatisfactory results with existing contracts, demographic changes to membership and associated health care issues, and the political climate in the provider community. Directly and indirectly influences Regional decisions related to hospital contracting and provider relations.
Assures Regional compliance with federal and state regulations, NCQA, CMS, SOX, as well as internal compliance regarding hospital contracts and provider relations. Safeguards the interests of Health Plan and MAPMG while allowing the maximum legal protections and flexibility for the organization.
Directs departmental staff to include interviewing, hiring, training, developing, mentoring, disciplining, evaluating, counseling, and terminating in conformance with established Kaiser Permanente EEO/AA goals and personnel policies.
This position has a target base salary of $225,000 to $281,250 and is eligible for incentive compensation, comprehensive health, wellness, time off, savings, and retirement benefits, as well as relocation support, as applicable.
Basic Qualifications:Experience
Minimum eight (8) years of increasingly responsible health care management experience that demonstrates leadership ability in creating and implementing strategic initiatives in hospital administration, contracting and network management.
Education
Masters degree OR six (6) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
Successful candidate will have extensive knowledge of hospital contracting, strategy development, health plan administration, health care compliance and regulatory issues.
Successful candidate will have the ability to analyze complex contracts and financials. Must possess a strong orientation toward superior provider and customer satisfaction and effective interpersonal and conflict resolution skills.
Knowledge and deep understanding of operations within Managed Care and domain
Experience leading large teams in highly matrixed organizations.
Preferred Qualifications:
N/A