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.
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