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Vice President, Network

Lumeris

Lumeris

United States · Remote
Posted on Thursday, June 27, 2024

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Position:

Vice President, Network

Position Summary:

Responsible for overseeing the successful development and implementation of provider network contracting strategies. Directs all provider contracting functions of the organization including, network development activities, contracting standards, provider negotiations, and value-based programs pertinent to provider contracting. Establishes and implements a contracting strategy that provides high quality, is cost effective and remains competitive within markets.

Job Description:

Primary Responsibilities

  • Develops, implements, and guides strategic direction for the department/function(s). Oversees, coaches, mentors, motivates, supports, and develops a cross-functional team of seasoned people leaders with a broad scope. Oversees goal setting/review, regular guidance and 1-1 check ins, career development/planning, upskilling, resource allocation, staffing, budget creation/management, succession planning, DE&I initiatives, and other People & Culture programs/activities as needed. Fosters accountability, collaboration, and innovation to ensure organizational goals are met.
  • Owns provider network strategy across the organization including access analysis and network operations.
  • Establishes the department's strategic vision, goals, policies, and procedures.
  • Develops, implements, and maintains production and quality standards for the department.
  • Oversees external consultants in the development of provider networks across expansion markets.
  • Assists CEO/President in key provider relations and strategy.
  • Engages with key partners for reviews related to reimbursement and unit cost management.
  • Performs periodic review of the provider network from a cost, coverage, and growth perspective.
  • Provides guidance in evaluating opportunities to expand or change the network to meet Company and/or external client goals.
  • Owns budgeting and forecasting initiatives for product lines to networks costs and provider contracts.
  • Oversees review of claim trend data and/or market information to derive conclusions to support contract negotiations.
  • Conducts periodic review of provider contracting rates to ensure strategic focus is on target with overall Company and/or external client strategy.
  • Supports market expansion and M&A activities by guiding provider contract review related to due diligence.
  • Collaborates with senior leadership on key provider relations and strategy.
  • Ensures provider compliance with ADA requirements, accessibility and accommodations.

Qualifications

  • Bachelor's Degree in Health Care Administration or Business or related field or equivalent
  • 15+ years of experience in managed care network development and provider relations/contracting management
  • Significant people leadership experience at an executive level with the proven ability to guide, coach, develop, support, and motivate a large cross-functional team
  • Expert knowledge of Network Development & Content, budget creation/management, resource allocation, and contract/vendor management
  • Exemplary business acumen, executive presence, and a demonstrated ability to build and enhance strategic relationships
  • Topnotch communication, presentation, and negotiation skills
  • Distinguished ability to impact results in a high-performing and high-growth environment
  • High-caliber analytical skills with the proven ability to identify, develop, communicate, implement, and guide process improvements and strategic initiatives

Preferred

  • Master's degree

Working Conditions

  • While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

  • The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

#LI-Remote

Lumeris is an EEO/AA employer M/F/V/D.

The hiring range for this position is:

$203,000.00-$295,250.00


Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page.

Member Facing Position:

No- Not Member or Patient Facing Position

Location:

Remote, USA

Time Type:

Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.