AVP, Health Partners and Network Strategy

Job Summary:

The Associate Vice President, Health Partners and Network Strategy designs and implements strategies to develop and increase provider engagement, driving toward better quality and Member satisfaction, improved population health, and reduced healthcare cost.

Essential Functions:

• Responsible to execute on Market Provider Relations Model and drive Market performance.
• Oversee and lead Market and Community Outreach
• Responsible for development and execution of Provider Networks
• Develop the key metrics to ensure a high level of network adequacy and ensure that timely and accurate reporting is relayed to the markets
• Responsible for robust competitor and provider competitive analysis and the creation of other
• Align and integrate operations, systems, and processes for Providers to ensure a collaborative partnership 
• Participate with the Market Expansion and Product teams to analyze new market targets
• Drive quality outcomes through execution of Value Based Reimbursement agreements with providers
• Collaborate with Enterprise and Market leadership on the development of overall program strategy and business objectives with respect to Providers
• Establishes objectives and annual goals in conjunction with the Market President
• Development of the Network strategy and execute defined initiatives to achieve Network goals
• Monitor and ensure the health plan’s execution of meeting or exceeding all appropriate requirements by Federal, State, and Accrediting bodies
• Responsible for translating business/program vision and strategy into operational tactics – collaborating to build the necessary enterprise matrix and market support infrastructure
• Lead large scale transformational change in the market, working effectively with all levels of the organization
• Foster external and internal intra/inter departmental relationships with hospitals, physicians, community agencies, trade associations and key vendors
• Collaborate with Provider/Health Partner Relations and Community Stakeholders to facilitate access, address barriers to care and improve coordination that support health care outcomes
• Develop health plan Network policies, procedures and goals as needed to align with the market requirements and CareSource strategy/model
• Ensure budget and financial goals are set in conjunction with the Market President
• Monitor health plan Network budgets; describe variance detail monthly with effective action plans
• Participate and represent CareSource internally and externally with speaking engagements, State and regional committee work
• Advocate for the populations and health plan at state and federal agencies
• In collaboration with Consumer Experience Team, monitor and analyze member satisfaction surveys to identify and develop appropriate action plans with reporting activities as needed
• In collaboration with Health partner and Quality Team, monitor and analyze provider satisfaction surveys to identify and develop appropriate action plans with reporting activities as needed Experience Team
• Produce team results that demonstrate engagement rates, low Grievances & Appeals, Continuous Improvement, Human Capital metrics that demonstrate leadership behavior is supporting improved outcomes, positive culture and consumer experience
• Develop and maintain an in-depth knowledge of the company’s business, regulatory environments and high-level of Health plan knowledge
• Support and fill in as needed at the Market President level
• Lead Market Operations and assist with the expansion as needed in any other identified markets
• Perform travel as needed to support program goals and key stakeholder engagement
• Perform any other job duties as requested

Education and Experience:

• Bachelor of Science/Arts Degree or equivalent years of relevant work experience is required
• Master’s degree in business or health care preferred
• A minimum of five (5) years of leadership/management experience is required
• A minimum of five (5) years of Managed Care experience is preferred

Competencies, Knowledge and Skills:

• Demonstrated management of multiple regulatory and accreditation requirements of populations and programs
• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
• Ability to operate smart phone, iPad, or other mobile communication devices
• Prior experience with and knowledge of provider contracting
• Knowledge of provider operations preferred
• Strong financial background
• Strong interpersonal skills
• Knowledge of managed care industry, trends, and accreditation
• Knowledge of quality improvement and HEDIS programs/outcomes measurement
• Excellent verbal and written communication skills
• Excellent leadership, management and supervisory skills
• Ability to work independently and within a team environment
• Attention to detail and work plan creation, implementation, and evaluation
• Critical listening and thinking skills
• Negotiation skills/experience
• Customer service oriented
• Decision making/problem solving skills
• Proven track record in driving continuous improvement efforts to improve member experience and tracked results
• Critical listening and systematic thinking skills
• Ability to attract, manage and develop team members, Inspirational Leadership
• Energetic, enthusiastic, and politically astute
• Strategic management skills
• Conflict resolution skills
• Planning, problem identification, and resolution skills

Licensure and Certification:

• Employment in this position is conditional pending successful clearance of a driver’s license record check.  If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• Travel may be required to travel 25% to 50% of the time to perform work duties; a valid driver’s license, car and automobile insurance are necessary for work-related travel
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer

Compensation range $150,000-$300,000.  CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Energize and Inspire the Organization

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.