Providence is calling a Vice President of Contracting and Network Development to Providence St. Joseph Health System in Irvine, CA.
This system-wide role is responsible for managing provider relations and network development for the medical groups across Providence St. Joseph Health System (PSJH). The Vice President of Contracting and Network Development is responsible for contract development, execution, and management for contracts between PSJH's medical groups and the respective payers, purchasers, and provider groups and facilities that the PSJH medical groups are aligned with. This position works collaboratively on strategy and contract development for California with the VP of Contracting and Payer Relations. This position supervises the Directors accountable for managing a team that does the contracting on behalf of St. Joseph Heritage Medical Group and its affiliates and Providence Medical Institute and its affiliates, including Providence Medical Group, Axminster, Providence Care Network. The VP of Contracting is also responsible for supervising the Orange County, Los Angeles County, and Northern CA Regional Directors of Contracting who will also be located in the California office.
In this position you will:
- Provide internal and external strategic direction for PSJH at the system and regional level regarding provider contracting and network development, specifically in a largely capitated environment such as California.
- Develop aligned relationships with the Medical group leadership, Regional leadership, and system leadership.
- Facilitate the maintenance of strong working relationships between the Directors of Network Development and the medical groups they serve.
- Advise system management in the overall direction for provider contracting and network development
- Responsible for developing and recommending strategic contract initiatives, desirable reimbursement methodologies and other arrangements that drive incremental volume, profitability and value.
- Lead the negotiation and implementation of national and large regional contracts for our network providers.
- Thought leader regarding network management and value creation for the system.
- Research and prepare organization in collaboration with applicable functional leaders, for federal/state health reform, plus regulatory issues in relation to health benefits, payer products and reimbursement methodologies
- Direct evaluation and contract modeling with managed care plans in support of payer negotiations.
- Develop strong relationships and partnerships with key payers to advance PSJH goals of managing the health of our population.
- Develop innovative risk sharing arrangements that increase opportunities for revenue growth and reward for appropriate management of total cost of a population
- Develop and negotiate rate structures within PPO, HMO and FFS products in manner that rewards PSJH for the spillover effect of managing the lives of a population.
- Work with payers to develop contracts that expand beyond our traditional service areas for Centers of Excellence and bundles.
- Represent PSJH to the payer community and regional leadership in proposing and promoting new financial arrangements that advance the strategic vision of managing a population of lives.
- Develop pricing methodologies in support of new programs or clinical business planning (i.e. bundles, centers of excellence, etc.) that align with our quality and performance goals as a system
- Educate leadership on emerging models of care and collaborate with appropriate system leadership to ensure development of the clinical, financial and operational infrastructure necessary to be successful in these new models of care.
- Report on provider performance and payer performance in the new models of care, so the future of these models can be evaluated effectively.
- Provide strategic financial direction in support of key strategic initiatives for long-range financial planning, capital expenditures and budgeting.
- Participate as leader on key system, medical group or board level committees, such as St. Joseph Heritage Provider Contracting Committee, PSJH Clinical Committee, or Providence Health System Medical Group Committees.
- Participates on an executive level with healthcare associations and other local, state or national stakeholder groups, as appropriate.
- Serve as the VP of Contracting and Network Development for PSJH in all regions, with direct accountability for California. This includes managing the Regional Director of Payer Contracting for California who will be matrixed to the VP of Contracting and Provider Relations.
Required qualifications for this position include:
- Bachelor's degree required, preferably in healthcare administration, finance, business, or related field.
- Master's degree in Business Administration (MBA), Health Administration (MHA) (or equivalent experience) required [Other advanced degrees may be considered depending on years of experience – JD, Ph.D., MD].
- Minimum ten years of experience in health care.
- Minimum 7 years of leadership experience with accountability for managing a team.
- Extensive experience leading high profile contract negotiations, business planning and strategic execution of initiatives.
- Minimum five years of experience working in a managed care environment on either the payer or provider side with experience in large capitated environments.
- Experience with managing provider contracts in California or a state with a similar regulatory environment (e.g. Corporate Practice of Medicine law; Managed Medicaid; Patient Privacy Regulations and Policies).
Providence St. Joseph Health was established on July 1, 2016, creating the second largest Catholic health system and fourth largest non-profit integrated delivery system in the country, which provides a broad range of health and outreach services throughout the western United States. With total revenues exceeding $20 billion in fiscal year 2015, the health system family includes 50 acute care hospitals as well as home health agencies, hospice care, outpatient services, skilled nursing facilities, insurance plans and physician organizations. Providence St. Joseph Health includes more than 100,000 caregivers, 829 outpatient clinics, 23,000 physicians, across seven states. The system has 1.9 million covered lives.
The Providence St. Joseph Health family includes:
- Providence Health & Services
- St. Joseph Health
- Covenant Health in West Texas
- Facey Medical Foundation in Los Angeles
- Hoag Memorial Presbyterian in Orange County, California.
- Kadlec in Southeast Washington
- Pacific Medical Centers in Seattle
- Swedish Health Services in Seattle
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Leadership
Req ID: 153597