MedStar Health
Director Network Contracting & Provider Strategy
MedStar Health, Washington, District of Columbia, us, 20022
Overview
Director Network Contracting & Provider Strategy
role at
MedStar Health
leads contracting value-based care (VBC) and network development strategies for the District of Columbia and Maryland health plans. Responsibilities include negotiating provider reimbursement rates and contract terms, developing value-based care arrangements, planning, directing, organizing and evaluating the implementation of strategic objectives to ensure access to a quality cost-efficient comprehensive provider network. Oversees network development and provider contracting, ensures cost containment initiatives, and formulates and implements policies to ensure compliance with regulatory, contractual and accreditation standards. Acts as corporate authority on all reimbursement and payment methodologies, including incentive and value-based care programs, for the DC and Maryland health plans. Leads collaboration with internal departments to provide optimal service to network providers and internal customers. Develops and oversees provider education programs and provides management, direction, development, problem resolution and leadership for the provider relations team. Primary Duties And Responsibilities
Oversee network development, recruitment, contracting and retention activities. Develop contract negotiation strategy to meet strategic goals. Manage the Provider Relations department (day-to-day operations, hiring, performance evaluations) and develop performance metrics and goals in collaboration with the MedStar Family Choice District of Columbia leadership team; provide guidance on development, performance, and productivity and recommend changes to improve efficiency and effectiveness. With guidance, expand MedStar Family Choice's Value-Based Care program by partnering with health care systems in DC and Maryland and implement programs and strategies related to managed care contracts. Lead, develop and implement alternative payment methodologies (shared savings, risk sharing, bundle arrangements). Collaborate with key stakeholders (finance, health plan leaders, operations and legal) to manage financial, operational and legal provisions of contracts; implement contracting processes for proposals, renewals, analysis, execution and configuration. Demonstrate knowledge of government programs with a focus on Medicaid. Assess market readiness in targeted states for network development and expansion. Ensure compliance with state and federal regulatory requirements related to applicable state laws. Provide supervision and mentoring of the Provider Relations and contracting team. Minimum Qualifications
Education Bachelor's degree in related field required Master's degree in business or in health care administration preferred Experience 8-10 years' experience in managed care/health care required 5-7 years' experience with state and federal programs such as Medicaid and Medicare; experience with provider pay-for-performance programs preferred. APR-DRG hospital reimbursement methodology and claims adjudication systems are required. Significant experience managing networks and provider relations for primary care and specialty networks with a focus on access to care; required. 5-7 years' experience in supervisory capacity required Licenses and Certifications No special certification, registration or licensure required Knowledge, Skills, And Abilities Strong analytical skills. Strong written and verbal communication skills and experience with formal presentations. Superior problem solving, decision making and negotiation skills. Ability to prioritize and manage multiple projects. Proficiency with word processing, spreadsheet and database applications. Experience in the managed care environment (e.g., Integrated Medical System in an administrative or finance setting or managed care organization/insurance company). Analytical and strong financial skills, contracting knowledge. Experience with data analysis and statistics. Proven experience engaging providers in meaningful dialogue to support quality and financial initiatives. Knowledge of complex managed care concepts, including provider recruitment, network development, and managed care contractual processes, including alternative reimbursement models associated with incentive and risk-based programs. Understanding of value-based care reimbursement models and healthcare contract experience in commercial and government contracting. Knowledge of multi-state and federal regulatory requirements; broad contracting experience in unregulated markets.
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Director Network Contracting & Provider Strategy
role at
MedStar Health
leads contracting value-based care (VBC) and network development strategies for the District of Columbia and Maryland health plans. Responsibilities include negotiating provider reimbursement rates and contract terms, developing value-based care arrangements, planning, directing, organizing and evaluating the implementation of strategic objectives to ensure access to a quality cost-efficient comprehensive provider network. Oversees network development and provider contracting, ensures cost containment initiatives, and formulates and implements policies to ensure compliance with regulatory, contractual and accreditation standards. Acts as corporate authority on all reimbursement and payment methodologies, including incentive and value-based care programs, for the DC and Maryland health plans. Leads collaboration with internal departments to provide optimal service to network providers and internal customers. Develops and oversees provider education programs and provides management, direction, development, problem resolution and leadership for the provider relations team. Primary Duties And Responsibilities
Oversee network development, recruitment, contracting and retention activities. Develop contract negotiation strategy to meet strategic goals. Manage the Provider Relations department (day-to-day operations, hiring, performance evaluations) and develop performance metrics and goals in collaboration with the MedStar Family Choice District of Columbia leadership team; provide guidance on development, performance, and productivity and recommend changes to improve efficiency and effectiveness. With guidance, expand MedStar Family Choice's Value-Based Care program by partnering with health care systems in DC and Maryland and implement programs and strategies related to managed care contracts. Lead, develop and implement alternative payment methodologies (shared savings, risk sharing, bundle arrangements). Collaborate with key stakeholders (finance, health plan leaders, operations and legal) to manage financial, operational and legal provisions of contracts; implement contracting processes for proposals, renewals, analysis, execution and configuration. Demonstrate knowledge of government programs with a focus on Medicaid. Assess market readiness in targeted states for network development and expansion. Ensure compliance with state and federal regulatory requirements related to applicable state laws. Provide supervision and mentoring of the Provider Relations and contracting team. Minimum Qualifications
Education Bachelor's degree in related field required Master's degree in business or in health care administration preferred Experience 8-10 years' experience in managed care/health care required 5-7 years' experience with state and federal programs such as Medicaid and Medicare; experience with provider pay-for-performance programs preferred. APR-DRG hospital reimbursement methodology and claims adjudication systems are required. Significant experience managing networks and provider relations for primary care and specialty networks with a focus on access to care; required. 5-7 years' experience in supervisory capacity required Licenses and Certifications No special certification, registration or licensure required Knowledge, Skills, And Abilities Strong analytical skills. Strong written and verbal communication skills and experience with formal presentations. Superior problem solving, decision making and negotiation skills. Ability to prioritize and manage multiple projects. Proficiency with word processing, spreadsheet and database applications. Experience in the managed care environment (e.g., Integrated Medical System in an administrative or finance setting or managed care organization/insurance company). Analytical and strong financial skills, contracting knowledge. Experience with data analysis and statistics. Proven experience engaging providers in meaningful dialogue to support quality and financial initiatives. Knowledge of complex managed care concepts, including provider recruitment, network development, and managed care contractual processes, including alternative reimbursement models associated with incentive and risk-based programs. Understanding of value-based care reimbursement models and healthcare contract experience in commercial and government contracting. Knowledge of multi-state and federal regulatory requirements; broad contracting experience in unregulated markets.
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