Vice President, Community and Provider Development

Clever Care Health Plan

New York, US
  • Job Type: Full-Time
  • Function: Marketing/PR/Product Mktg
  • Post Date: 04/03/2021
  • Website: clevercarehealthplan.com
  • Company Address:

About Clever Care Health Plan

Clever Care Health Plan is a healthcare company that offers medicare advantage health plans to its members.

Job Description

About Clever Care Health Plan Clever Care Health Plan is a newly founded Medicare Advantage health plan and serves Medicare beneficiaries in Southern California. We are expanding and looking for an experienced network development executive to lead network development activities in NYC. Our employees are passionate in providing best services to our members and healthcare providers. To learn more, please visit CleverCareHealthPlan.com.


We are looking for a VP, Community and Provider to direct the provider network and contracting activities. He/she will lead all aspects of provider network strategy including in the New York market, achieving CMS network adequacy, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the contracting department. Develop relationships with community resources and contract as appropriate. Lead all physician relationship development and collaborate with Sales and Marketing to drive membership growth and retention.


Functions & Job Responsibilities

Establish the department’s strategic vision, objectives, and policies and procedures.
Establish and maintain CMS network adequacy and manage applicable CMS reporting.
Partner with Sales and Marketing to drive member growth by establishing and growing aligned PCP and IPA relationships.
Develop aligned relationships with strategic IPA partners.
Develop community relationships to establish Clever Care as a community partner.
Ability to execute the Clever Care Contracting Strategy by understanding the model, achieving Provider acceptance, and supporting the successful implementation and operations of the contract so that both Clever Care and Providers achieve their goals.
Oversee network development staff and external consultants in the development of provider networks across expansion markets.


Perform periodic analyses of the provider network from a cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet Company goals. Ensure Clever Care maintains CMS network adequacy.
Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts.
Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations
Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy.
Support market expansion and M&A activities by leading provider contract analysis related to due diligence.
Ability to travel.
Other projects as assigned by COO.


Qualifications

Education: Bachelor’s degree in business or healthcare required, Master’s degree (MBA, MHA) preferred or equivalent experience.
Experience: 10+ years network development. 5+ years of value-based care (VBC) and full risk contracting. 7+ years Medicare Advantage experience required.
Skills: Strong organizational skills and ability to multi-task. Ability to write clearly and effectively. Excellent verbal and written communication and presentation skills. Effective interpersonal skills. Proficiency with Microsoft applications, especially Microsoft Office. Ability to work both independently and as part of a team.


Physical Demands and Working Environment

Typical Physical Demands. Position requires a great amount of driving, sitting and standing. Some standing, stooping, bending or reaching is required. May require lifting up to 15 pounds. Requires manual dexterity sufficient to operate a computer, calculator and telephone. Requires normal range of hearing and vision. Requires the ability to type and file.
Typical Working Conditions. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. Work may be stressful at times. Contact may involve dealing with angry or upset people. Position requires flexibility with work schedule to accommodate participation with contracted network client boards of directors and physician dinner meetings. May occasionally work some irregular hours.


What’s in it for you?

1.A competitive compensation and benefits program.
2.Generous paid-time-off (PTO).
3.Ten paid holidays per year.
4.Excellent 401k saving plan, employer provides up to 4% match and employer contribution match is 100% immediately vested.
5.A work-life balance and much more!

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Disclaimer: Local Candidates Only
This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.