VP, Provider Networks and Contracting
VP, Provider Networks and Contracting
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
We take great strides to ensure our employees have the resources to live well be healthy continue learning develop skills grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
Job Summary/Position Purpose:
This position will provide overall leadership and management for Provider Networks and Contracting activities. Will be charged with establishing and overseeing all aspects of the corporate provider network management functions including provider negotiations provider contracting network development and provider contract management.
How You Contribute to the Companys Mission in this Role:
- Ensures that provider networks support the Plans product portfolio and provide the appropriate level of access and reimbursement so that the Plans products are competitive.
- Works cross functionally to develop network strategies articulate risk arrangements and monitor network and contracting functions to support the strategic direction of the company achieve corporate goals and create significant incremental value for members customers and providers.
- Develops leads and aligns the execution of both short-term tactical initiatives and long-term strategies which will facilitate the organizations ability to meet or exceed operating annual medical cost budgets and Medical Loss Ratio (MLR) targets.
- Develops the necessary programs and services to guarantee a high level of provider satisfaction and corporate efficiencies related to provider network management and electronic claims and inquiries.
- Manages budgeting and forecasting initiatives for network costs and provider contracts.
- Uses analysis based on claim trend data and/or market information to derive conclusions to support contract negotiations.
- Conducts regular review of provider contracting rates and network design.
- Integrates with the reimbursement staff and assures contracting processes are current and consistent with new payment methodologies.
Required Qualifications:
- Bachelors degree in business administration accounting or a related field. Four years of related experience can be used in lieu of a bachelors degree.
- 7 years of leadership experience in healthcare or related environment.
- 5 years of operations management experience in healthcare or related environment.
- 3 years of experience in negotiations and executing contracts in payer and/or provider organizations including leading complex contract negotiations.
- Experience can run concurrently.
- Must be an expert negotiator with industry knowledge.
- Must have strong interpersonal skills with external contacts internal Plan staff as well as with the department staff within the Provider Networks & Contracting Department.
- Must have strong financial acumen and a comprehensive understanding of contractual options and healthcare economics.
- Must have strong legal knowledge base to facilitate communication with payer and provider legal teams.
- Excellent command and proven experience with critical face-to-face communication and presentation skills are required.
- Must have a keen understanding of competitive factors in the market place and current demands that can affect negotiation outcomes with providers.
- Must have experience writing editing and developing complex contractual documents.
- Residing in or around Baton Rouge La is required.
- Frequent travel in and around the state required.
Preferred Qualifications:
- Masters Degree in Health Care Administration Business Administration or a related field.
Licenses and Certifications
- None Required
Additional Accountabilities and Essential Functions
- Perform other job-related duties as assigned within your scope of responsibilities.
- Job duties are performed in a normal and clean office environment with normal noise levels.
- Work is predominately done while standing or sitting.
- The ability to comprehend document calculate visualize and analyze are required.
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An Equal Opportunity Employer
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Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive only those most qualified will be contacted. To monitor the status of your application please visit the My Applications section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application please contact for assistance.
In support of our mission to improve the health and lives of Louisianians Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke and in order to promote good health our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration criminal courts federal state and county repositories of criminal records Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994 individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
Required Experience:
Exec
Employment Type
Full-Time
