The Vice President, Provider Network who will be Responsible for the leadership and direction of the Provider Relations and Vendor Management department. Responsible for tracking all performance metrics and analysis of contract performance for Physical Medicine, Home Health, DME, Diagnostics, Dental, Transportation, and Language Services. Ensures that the department and staff remain current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes. Ensures department achieve monthly, quarterly and annual goals and objectives.
Job Title: Vice President, Provider Network
Reports to: CEO / President
- Develops and recommends policy changes related to provider recruitment and contracting.
- Establishes recruitment plans for contracting with eligible providers.
- Oversee recruitment and negotiations of contracts with specific providers within operational and company requirements.
- Oversees training and communication for network providers and acts as a liaison for high volume key providers.
- Implements and ensures compliance with pricing guidelines.
- Ensures provider contracting is consistent with payment methodologies and below workers’ compensation fee schedules to remain profitable.
- Maintains familiarity with workers’ compensation fee schedules by state and analyzes comparable pricing guidelines.
- Resolves difficult complex contract issues to ensure that provider contracts are in compliance with state, federal, national accrediting agencies and MTI contracting guidelines.
- Ensures that non-standard contract elements are communicated to appropriate departments and obtains the CEO’s approval prior to submission to provider.
- Responsible for compliance with accrediting agencies’ network adequacy standards.
- Works with VP of Operations to ensure provider networks meets the needs of client’s coverage areas.
- Establishes a priority list of new geographic locations and types of providers to be added to the network in concert with scheduling departments.
- Augments and modifies the existing provider network to accommodate new products or clients as necessary
- Responsible for departmental staffing recommendations and ensures department staff annual performance reviews are completed.
- Leads team in a manner conducive to ongoing growth and expanded knowledge of associates.
- Coach team members in the use of data and appropriate analytical tools that support improved quality.
- Support team members in the identification and creative problem resolution for improved processes and expanded use of technology.
- Support collaborative team efforts that produce effective working relationships and trust.
- Systematically keeps staff informed of policy and procedural changes affecting program and administrative operations.
- Regularly suggests innovative means of structuring operations in a fashion that helps alleviate backlogs and ensures the optimal utilization of resources.
- Ensure resolution of individual provider complaints in a timely manner.
- Other duties as assigned
- Bachelor’s Degree in Business or health related discipline such as Healthcare Administration or Healthcare Management or equivalent business experience.
- Minimum five (5) years provider contracting/reimbursement leadership experience in healthcare setting; preferably in a managed care setting.
- Minimum 3 years of workers’ compensation experience preferred
- Ability to work on several projects simultaneously with excellent organizational skills
- Ability to communicate effectively for support of coaching, training and development
- Ability to work well with a diverse group of people
- Ability to be flexible in handling changing priorities and work processes
- Strong problem-solving skills
- Strong Written, verbal communication, and interpersonal skills
- Exemplary coaching / motivational skills at both an individual and team level.
- General computer literacy, including proficiency in MS Office suite products (Word, Excel, Outlook and Power Point)
- Travel 10-15% based on business needs
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Individuals may need to sit or stand as needed. May require walking primarily on a level surface for periodic periods throughout the day. Reaching above shoulder heights, below the waist or Lifting as required to file documents or store materials throughout the work day. Proper lifting techniques required. May include lifting to 3 pounds for files, computer printouts on occasion.
For roles located in the field; this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands, and fingers speak, and hear.
Auditory/Visual: Hearing, vision, and talking. Specific vision abilities required by this job include ability see things from a close distance and ability to adjust focus
Work Environment: Utilizes fluorescent lighting; noise level is moderate. For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office
The Job Description is subject to change at any time
MTI is an Equal Opportunity Employer