VP Provider Network Pricing
VP Provider Network Pricing
Location: Philadelphia, PAPrimary Job Function: Provider NetworkID
Responsible for managing a team tasked with developing contract modeling for provider negotiations and supporting the negotiation processYour career starts now. Were looking for the next generation of health care leaders.At AmeriHealth Caritas, were passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, wed like to hear from you.Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
The VP, Network Pricing is responsible for managing a team tasked with developing contract modeling for provider negotiations and supporting the negotiation process, using historical claims analysis and predictive modeling at a service-category code level and at total medical loss ratio (MLR). This includes integrated delivery systems, hospital systems, physician groups, and ancillary providers, as well as capitation agreements. Analyzes and identifies new program savings opportunities and provider contract opportunities. Performs financial reconciliation and approval for all risk-based contracts. Working with the financial actuary team, tracks changes and advises of trend impacts._Specific responsibilities include:_+ Lead and manage a team that supports Provider Network (physicians, hospitals, pharmacies, ancillary facilities, etc.) contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting+ Lead and manage a team that conduct unit cost and contract valuation analysis in support of network contracting negotiations and unit cost management strategies; responsibilities also include managing unit cost budgets, target setting, performance reporting, and associated financial models+ Provides and coordinates provider network configuration in support of new product development+ Leads financial support and reporting for all capitation, full risk, risk-sharing, accountable care and value based contracting efforts+ Leads team responsible for maintaining national reporting database of value based contracting and reporting national results+ Key leader in financial evaluation and development of strategy to achieve competitive provider economics in all markets+ Coordinates with all senior leadership, other key leadership in development and execution of key initiatives_Additional Responsibilities:_+ Lead and direct others to resolve highly complex or unusual business problems that affect major functions or disciplines+ Drive programs that impact markets of customers and consumers per requirements+ Work collaboratively with other areas of the organization with the goal of advancing the competitive position and results+ Interact with all levels of the organization
+ Undergraduate degree, Advanced degree preferred+ 10+ years of analytical experience in financial analysis, healthcare pricing, network management, healthcare economics, or related discipline+ 8+ years of experience with provider payment methodologies and healthcare products+ Advanced level of proficiency in performing financial impact analysis, risk management, and data manipulation+ 8+ years of experience in creating and using financial modeling tools, spreadsheets, and information acquisition tools including experience in interpreting and reviewing financial modeling results to evaluate the financial impact of contract changes and develop forecasts+ 5+ years of supervisory experience+ Strong written and verbal communication skillsEOE Minorities/Females/Protected Veterans/Disabled