VP of Network ManagementWill work in the San Diego or South Orange County area remotelyWill be leading a new acquisitionSalary at $200-230K with 20% bonusJob Summary:Responsible for achieving regional financial metrics, benchmarks, membership targets and physician development goals, while ensuring quality and satisfying service to members, physicians and provider partners. Develops and implements strategic expansion plans, executes revenue-driven initiatives in a highly competitive marketplace and achieves membership growth goals via retention & new growth. Works closely with IPA/MSO clinical leadership to help achieve metrics while ensuring access and meeting regulatory requirements. Responsible for ensuring compliance with company and regulatory requirements, mandates and ACA reform. Identifies technology and procedure improvements for increased efficiencies, accuracy and continuous process enhancements. Implements strategies across all lines of business considering product-specific factors to optimize patient care and network performance.Duties:Impacts Prospect's profitability and market position in assigned region by managing the following: strategic membership growth initiatives, medical loss ratio, performance program compliance (HEDIS, P4P, STARS), RAF score improvement, clinical care program participation, encounter data submissions, provider satisfaction, provider contract strategy and physician rewards / bonus programs. Provides leadership, mentoring and management to Network Managers and support staff to advance team members, while developing metrics and tools to measure/effect progress on team goals: increase revenue and reduce unnecessary expenses; grow membership strategically; build strong relationships with providers and health plans; and achieve quality performance metrics. Ensures team's compliance with company policies, procedures and workflows and strategic use of tools and reports.Perform and supplement network development and expansion functions, including identification of viable physician practice acquisitions to meet identified Fiscal Year metrics. Work with internal regional teams to facilitate leads and procure and engage external prospects. Coordinate initial acquisition data retrieval, coordinate with designated PMS Financial Planning & Acquisitions team for analytics via interface with potential acquisition practice to obtain necessary documents for negotiations. Collaborate and market networks with brokers and health plan career agents to increase membership across targeted product lines. Identifies and seizes new business opportunities to ensure achievement of revenue-driven objectives.Thoughtfully expands contracted provider base, exclusivity arrangements and niche network opportunities. Ensures tactical region development, specialist panel progression and provider maintenance to attract and retain members. Maintains effective relationships with providers and nurtures partnerships with health plans, hospitals and local community resources.Organizes and/or conducts effective Joint Operation Committee meetings and/or management review sessions with designated providers and/or groups to further company goals.Qualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. This job description reflects management's assignment of essential functions. It does not prescribe or restrict the tasks that may be assigned. Requirements listed below are representative of the knowledge, skill, and/or ability required.Proven success in achieving & surpassing key performance metrics, including membership growth, physician performance and financial targetsWorking knowledge of federal and state legislation related to HMO & IPA entities, including Department of Managed Health Care, Centers for Medicare/Medicaid, and Department of Health Services.Strong written, verbal, and presentation skills. Ability to effectively present information and respond to questions from senior management, employees, physicians and patients.Ability to shift from a high-level strategic focus regarding initiatives to a detail-oriented task-driven focus as well as working concurrently on a variety of tasks/projects with competing deadlines and turnaround times.Ability to motivate and engage staff, building trust and consensus, and appropriately delegating and empowering a high-caliber professional team.Must have advanced reasoning and highest level of problem solving and planning skillsEducation/Experience:7+ years of experience in the healthcare industry, preferably with direct physician interaction5+ years of experience with management and metric management in a process and/or service environmentBachelor's degree required, advanced degree preferredStrong computer skills, Word, Excel, Access, Power Point, and office equipmentIDX experience highly desirable San Diego, California Market Experience is Required
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