AVP Health Plan Relationships and Contracting

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AVP Health Plan Relationships and Contracting

Location: Washington, DC, United States

Posted on: Nov 20, 2020

Profile

Description:
Help grow one of the leading value-based, senior-care providers in the country. Partners in Primary Care and Family Physicians Group (collectively the Care Delivery Organization) are one of the largest and fastest-growing value-based, senior-focused primary care platforms in the country. Operating as a payer-agnostic, wholly owned subsidiary of Humana, Inc., the Care Delivery Organization has more than doubled its footprint in the last two years. Following the creation of a $600M joint venture with Welsh, Carson, Anderson, and Stowe, a leading health care private equity firm, in February 2020, the Care Delivery Organization is on-pace to double again in the next few years.
To support that growth, the Care Delivery Organization (CDO) is building out its contracting function. That team is charged with accelerating the Organization's organic growth through execution of a comprehensive contracting strategy.
This role is crucial in ensuring the CDO achieves its goals by securing access to prospective patients and collaboration with payers and other providers to improve quality and cost. With the CDO's rapid expansion, contracting activities continue to grow substantially in volume, financial impact, and complexity. Existing contracts must be continually renegotiated and aggressively managed. This role will manage medical cost through contracting initiatives and analysis of financial reports and trends in the marketplace. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care, primary care and MSO services. This position reports to the VP, Chief Growth Officer, Care Delivery Organization.

Responsibilities:
Key Responsibilities:
- Health plan relationship development and management: Introducing the CDO to local and national leaders of health plans, finding win-win collaboration opportunities and ensuring operationalization of key growth, quality and efficiency strategies.
- Value-based contracting: Representing the CDO's value proposition to key local and national health plan contracting decision makers, negotiating value-based contracts aligned with the CDO's preferred format, and innovating collaboration with payers to sustain the CDO's competitive advantage in the marketplace.
- Contract Management: Direct leadership and supervision of a team that manages administration of contracts, physician roster management, CDO presence in payer directories, claims payment issues, etc. Enhance the systems and processes necessary for optimal contract management.
- Partnering with CDO Markets: Develop joint strategic plan to support market growth with local CDO market leadership teams.
- Fostering Collaboration with External Stakeholders: Establish collaborative forums with local and national health plan leadership teams and key providers to advance shared objectives.
- Team: Develop and direct supervision and management of a newly-established team of distributed and local health plan relationship management and contract management professionals.

Key Deliverables (12-18 month horizon):
- Select and implement a contract management system.
- Define the standard operating model for the team.
- Achieving scalability of back office functions.

Key Candidate Qualifications:
The successful candidate will have extensive experience (ideally 7 years) in health care administration, specifically in the payer and/or provider contracting field. He/she will also have a demonstrable network of broad, deep, and relevant relationships with health plan leaders and/or track-record of developing such relationships. Proven ability to negotiate risk-based and capitated contracts with health plans and affiliate or downstream contracts with providers is critical for success in this position.
In addition to the above, the following professional qualifications and personal attributes are also sought:
- Strong collaboration skills with broad group of internal and external stakeholders.
- Deep understanding of Medicare reimbursement, Medicare Advantage health plan economics, and value-based and capitation contracting models.
- Demonstrated success negotiating value based contracts with various health plans.
- Technical understanding of contracting 'back-office' functions.
- A proven record of success in building, developing, and leading a high-performing team of contracting professionals.
- Excellent oral and written communications skills.
- Strong process design and execution orientation.
- Bachelor's degree in a relevant field is required; Master's degree strongly preferred.

The Professional Development Opportunity:
This role is a great opportunity for anyone with deep healthcare contracting experience to further their career. It offers the opportunity to develop deep sector and business expertise, working with some of the leading practitioners in the country.