Vice President of Networks Management; Hybrid

PURPOSE

Responsible for building and executing new collaborative relationships with health care delivery partners to advance and accelerate adoption of new payment models that align incentives more closely with value-based payment methodologies and further away from volume-based fee for service approaches. These collaborations are designed to create measurable value in health care and slow growth in health care cost over time. In addition, the executive is responsible for managing various regulatory and accreditation requirements in regard to adequacy and maintaining the competitiveness of the Care First providers networks using all available levers to drive development of access in specific geographies to ensure equitable access to healthcare.

The incumbent drives the creation of value through a variety of existing and emerging contracting strategies which includes a mix of fee for service, population based, capitation, medical loss ratio and episode of care contracting approaches for all lines of business. The incumbent will be expected to work a portion of their week from home and a portion of their week at a Care First location based on business needs and work activities/deliverables that week.

• Develop, execute and adjust a growth-oriented network roadmap and strategy designed to use Care First's health care spending to intentionally reshape the care delivery system in a way that promotes improved value, access, and outcomes for the community's investment in health care services. Considers the impact of regulatory framework on current and future plans and drives public policy agenda when appropriate to ensure the protection of Care First accounts.
  
  Ensures compliance with all existing and new regulations.
• Actively drives cost of care initiatives related to the provider network by contributing to cross-functional groups with specific affordability objectives. Develop, implement and maintain new and innovative payment methods to provider organizations to thoughtfully and efficiently finance the transition from a volume-based health care system to one that rewards value creation, and at the same time leads the strategic development and maintenance of the Care First base fee schedules and reimbursement methodologies and oversight to the analysis used in all FFS provider negotiations.
  
  Directs and controls departmental functions associated with the process of negotiation and maintenance of Professional, Ancillary, and Institutional contracts (including DC and VA hospital contracts) for all lines of business. This includes negotiating, financial analysis and quantification, networks impacts, qualification and competitive analysis and implementing all non-standard contracts. Responsible for the Care First provider agreement templates used to contract all providers in one or many networks.
  
  Identifies and implements opportunities to improve workflows, drive administrative efficiencies and leverage technology for better results.
• Maintain and support a dynamic provider network of care delivery partners through contracting and negotiation teams, provider relations, population health consulting, and access and capacity analysis for all applicable market segments in multiple geographies. Where appropriate, shepherds the connection of Care First network and all value-oriented contracts to the BCBSA to ensure Care First is supporting the broader goals and objectives approved by the BCBSA.
• Influence transformation of provider organizations leveraging Care First's data, analytic and reporting capabilities, leveraging practice transformation consultants to support health care delivery organizations in value-based contracts to make progress to value creation including better affordability, better access, and better outcomes on quality and member experience measures.
• Identify opportunities, and serve as the sponsor of specific initiatives, to establish new analytic capabilities that improve the quality and timeliness of actionable data in support of health care delivery system transformation and improves the access across geographies and intensify the effectiveness of population health activities. This includes claims data, clinical data and multi-dimensional utilization and geographic access data.
• Responsible for oversight of senior relationships with key health care delivery partners including practice transformation, data sharing and other activities used to drive the best value and outcomes in innovative payment…