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Vice President of Provider Contracting and Value-Based Partnerships

Job Ref: 79607
Category: Professional
Department: PROVIDER CONTRACTING
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $230,000.00
Salary Range: $230,000.00 - $240,000.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview:

The Vice President of Provider Contracting and Value-Based Partnerships will provide administrative and management support necessary to achieve the goals and objectives of MetroPlusHealth, specifically as they relate to ensuring a comprehensive cost efficient and accessible provider network that is contracted and linked to appropriate fee schedules. Also, this position will serve as the organization’s senior leadership liaison, on contracting matters with all departments involved in contracting processes.

Job Description

  • Negotiate contracts and manage relationships with participating Hospitals, IPAs, Ambulatory Surgery Centers, SUD sites, Behavioral Health Providers, Urgent Care facilities, and Physician Groups and key specialty providers (e.g., Optometry);
  • Help develop both the short- and long-term network and contracting strategies for the Plan;
  • Manage the Senior Director to ensure end-to-end contracting process, including outreach, recruitment, contract initiation, amendment mailings, and provider non-renewals and terminations;
  • Develop in conjunction with Executive Leadership a comprehensive Value Based Payment strategy with key provider partners;
  • Coordinate with the Credentialing Director and department;
  • Coordinate with the Provider Maintenance Manager, and the Provider Maintenance Department;
  • Coordinate with the Special Investigations Director and department;
  • Negotiate and review all existing and proposed hospital and large provider contracts. Ensure that reimbursement is competitive, and appropriate for the facility, for the product line, and identify cost saving opportunities for MetroPlus;
  • Manage both the Physical and Behavioral Health provider network; ensure adequacy; ensure payment is competitive and meets regulatory guidance.
  • Coordinate MetroPlus’ network development and contracting strategy as MetroPlus expands into new lines of business;
  • Work with Legal to review and modify any negotiated provider contract language changes as necessary and appropriate;
  • Manage an Out-of-Network strategy that addressed high cost out-of-network cases for all lines of business, but primarily for the Commercial and Exchange products;
  • Manage the process for Single Case Agreements and work closely with Legal and Regulatory on Independent Dispute Resolution processes:
  • Supervise a team of: Senior Director, Director and Managers and manage the budget for the entire department;
  • Providing support necessary for the development of policies and strategic direction for expansion of a comprehensive network;
  • Work with Finance and Analytics Department on rate development and related activities, specifically as they relate to the evaluation and analyses of reimbursement structures consistent with industry norms and trends and cost containment initiatives;
  • Work with Analytics Department and Reimbursement to address all contract-monitoring activities, specifically as they relate to providers’ compliance with contract terms and conditions;
  • Collaborating with MetroPlus departments in the development and evaluation of proposals for operational improvements and new products, and make recommendations as they relate to improved performance and cost effectiveness;
  • Assist Marketing and Network Relations Departments in directing and maintaining relationships with providers through education and provider relations efforts, including assistance in Marketing initiatives to promote membership growth;
  • Perform other related functions as required.

Minimum Qualifications

  • Master’s Degree in Business, Health Care Administration, or related field, required.
  • Minimum of 7-10 years senior management experience in Contracting, including a minimum of 5 years managed care contract leadership experience in New York State.
  • Proven ability to achieve organization’s missions, goals and objectives or an equivalent combination of education and experience.

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical Skills
  • Written/Oral Communication