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Vice President, Network Management

Company: Tufts Health Plan
Location: Canton
Posted on: June 3, 2021

Job Description:

We enjoy the important work we do every day on behalf of our members.Job SummaryThe Vice-President of Network Contracting, Public Plans contributes to the overall financial performance of the division by delivering hospital and physician network and unit cost targets for Public Plans products. Working closely with Public Plans product teams and in collaboration with the enterprise network functions, the Vice-President develops contracting strategy, performs contracting analytics, negotiates contracts and ensures accurate implementation of contractual terms. This role will oversee a team consisting of contract managers and analysts.Job DescriptionNetwork strategyContracting Strategy The Vice-President of Contracting works closely with each Public Plans product team and, when appropriate, the Chief Medical Officer to develop product-specific contracting strategies, and works with the Public Plans president and CFO to ensure necessary coordination across productsProduct-specific contract strategy will be supported by a robust analytical framework that allows for comprehensive and dynamic analysis and reporting of contracting options and scenariosThe Vice-President will partner closely with Enterprise Actuarial and Finance, as well as the Public Plans CFO, to provide unit cost inputs for business planning and forecast purposesContract negotiationThe Vice-President works with each product team to define roles and responsibilities in specific negotiations, as well as the building and expanding of relationships with new or current network providers, as the context of negotiation and provider relations relative to broader product strategies and needs may vary from product to product, and provider to provider.She/he leads the contracting team in the end-to-end negotiation process:A primary accountability for this role is delivering the pre-set unit cost target for each product for a given year.As appropriate, will coordinate with other LOB contracting functions on negotiations with the same providersContract implementation oversightThe Vice-President ensures the accuracy and timeliness of contract implementation and maintains a reliable process in which their team delivers contract provisions downstream with adequate visibility. This explicitly includes mastering knowledge of the State RFA and ensuring that the applicable provisions and reimbursement terms are accurately reflected in the system and operational processes in a well-documented, up-to-date manner. This role will work regularly with Provider Reimbursement, Configuration, and Claims functions to monitor contract implementation accuracy and trouble-shoot issuesRequirementsEDUCATION: Required: Bachelor's Degree, 10+ years of experience in payer or provider organizations, deep knowledge of payer-provider contracts, including reimbursement methodologies and common business provisionsPreferred: Master's/MBA, Direct experience in contracting, Work experience in the local (MA and RI) health care market strongly preferredEXPERIENCE:Minimum 10 years of professional experience.SKILL REQUIREMENTS:WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: 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.What 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 30 Days Ago Full time R2270 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 Management, Other , Canton, Michigan

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