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Director of Value Based Contracting

- Fulltime   Director of Value-Based Contracting
The Director of Value-Based Contracting & Network Development will report to the Vice President of Network Management and will oversee the contracting activities. The position has direct reports, who collaboratively produce work aimed at supporting and strengthening our mission.

The Director of Development & Contracting will lead all aspects of provider network strategy, overseeing the development and execution of strategies that position client, its leadership and business favorably. To do this, this position is responsible for daily decision-making, anticipating challenges and future needs.

The position must be able to understand our goals and desired outcomes in relation to the contracting & network development functions. As such, the ideal candidate for this role has proven experience leading cross-functional initiatives, managing a multi-discipline workforce.
Essential Functions
  • Lead all aspects of provider network strategy and contracting activities, including access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management.
  • Oversee the coordination and negotiation for contracting, safeguarding contract and credentialing compliance.
  • Establish the department's strategic vision objectives and policies & procedures.
  • Develop and implement a departmental strategy focused on production and quality standards for contracting in order to meet organizational objectives.
  • Oversee the network development staff in the development of provider networks.
  • Perform periodic analyses of the provider network from a cost, coverage, and growth perspective.
  • Negotiate competitive and complex, value-based contractual relationships with providers according to pre-determined internal guidelines and financial standards.
  • Build relationships with value-based contracting groups and their associated teams.
  • Lead efforts and accept responsibility for the financial and quality of performance of value-based contract.
  • Collaborate with value-based contracting provider groups to achieve the quality performance benchmarks established in the contract.
  • Lead change management to ensure a successful practice performance under value-based contracts.
  • Design, deploy, and provide ongoing monitoring that addresses provider performance gaps for quality metrics and benchmarks related to value-based care initiatives.
  • Establish oversight, monitoring and management processes aimed at optimizing results, including defining the underlying metrics of value-based programs and alternative payments models.
  • Expand value-based contracted provider network, exclusivity arrangements and network opportunities, while maintaining relationships with providers and external partners / resources.
  • Provide leadership in evaluating opportunities to expand, enhance or change the alternative network payment model to meet company goals and manage networks costs & provider contracts.
  • Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.
  • Conduct periodic review of alternative payment models and value-based provider contracting rates to ensure strategic focus is on target with overall company strategy.
  • Oversee network development staff and external consultants in the development of provider networks across counties.
  • Partner with leadership to ensure process change needs are identified and developed, and that related ongoing training is available.
  • Provide training, ongoing mentoring and consultation to department members, providers, and internal staff on Cardinal Innovation’s applicable policies and procedures.
  • Assist Vice President of Network Management and/or COO with key network development strategies.

Knowledge, Skills and Abilities:  
  • Able to read and comprehend complex written materials as well as spoken information. 
  • Able to establish and maintain effective working relationships with internal and external customers, as well as ensure direct reports are doing the same.
  • Demonstrated skills and experience in collaborative, strategic and analytical thinking.
  • Proven experience uncovering obstacles and implementing an innovative troubleshooting approach.
  • Strong interpersonal skills and demonstrated ability to take leadership simultaneously on multiple projects.
  • Proven ability to manage large-scale projects in a fast-paced, deadline-driven, and highly collaborative environment.
  • Expected to work well in a technically complex environment.
  • Display willingness to make timely decisions; exhibits sound, accurate and independent judgment.
  • Ability to travel.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Work Experience
  • Bachelor’s Degree or equivalent work experience in Business Administration, Healthcare Administration or related field. Advanced degree ideal.
  • Advanced proficiency with Healthcare, Managed Care Organization, or Managed Behavioral Healthcare.
  • 10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment.
  • At least 5 years of experience managing a staff of direct reports, including responsibilities for hiring, training, assigning work and managing performance of staff.
  • Proficient with MS Office suite (Word, Excel, PowerPoint).
  • Entrepreneurial spirit with a demonstrated ability to work collaboratively and influence others.
  • Effectively communicate at all levels of the organization both internal and external. 
  • Experience in strategic positioning, developing, executing and adhering to business plans.