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Vice President, Network Strategy and Operations

Company: Tufts Health Plan
Location: Canton
Posted on: April 10, 2021

Job Description:

Vice President, Network Strategy and Operations Canton, MA We enjoy the important work we do every day on behalf of our members.Job SummaryResponsible for leading the execution of network operations related functions for all lines of business as well as strategic oversight of risk-based contract advancements for the organization. Including, Ancillary contracting, provider relations, provider contract implementation, provider information management, and payment integrity. The scope also includes partnering with all functions in each lines of business.Job Description

  • Lead strategic development of enterprise approach to next generation risk-based contract framework
    • In collaboration with lines of business (LOB), oversees the strategic development and implementation of provider network contract & reimbursement methodologies to support current & future business goals.
      • Oversee contract implementation, ensuring all key terms are correctly configured in claims administrative platforms
        • Ensure continual innovation and improvement on payment integrity processes
          • Ensure a robust, affordable network of innovative ancillary providers
            • Oversee provider communication, education, and second level dispute resolution on systemic claims payment issuesRequirementsEDUCATION: (Minimum education required)
              • Bachelor's Degree required. Master's Degree preferred.EXPERIENCE: (Years of experience)
                • Minimum 10 years of professional experience.SKILL REQUIREMENTS: (Include interpersonal skills)
                  • Leadership and management skills are necessary. Must be able to communicate effectively with all levels of management and work cooperatively as a team member.WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)
                    • Fast paced, professional office environment handling multiple demands. Employee must be able to exercise appropriate judgment as necessary. Occasional local travel to other sites or vendor meetings.CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.*Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment. Ability to learn and apply company policies consistently, seeking out guidance when necessary, is required.THIS DESCRIPTION IS NOT INTENDED TO BE A COMPLETE STATEMENT OF JOB CONTENT; RATHER IT ACTS AS A GUIDE TO THE ESSENTIAL FUNCTIONS PERFORMED. MANAGEMENT RETAINS THE DISCRETION TO ADD TO OR CHANGE THE DUTIES OF THE POSITION AT ANY TIMEWhat we build together changes our customer's health for the better.We are looking for talented and innovative people to join our team.Come join us! Posted 4 Days Ago Full time R2245 About Us A nonprofit organization founded in 1979, Tufts Health Plan is nationally recognized for its commitment to providing innovative, high-quality health care coverage. We strive to improve the health and wellness of the diverse communities we serve. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us one of the Top Places to work in the area.--

Keywords: Tufts Health Plan, Canton , Vice President, Network Strategy and Operations, Executive , Canton, Michigan

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