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Vice President, Contracting

Date: May 26, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5149 

 

Position Summary/Position

 

The Vice President, Contracting under the direction of the Chief Network Officer (CNO) and in close partnership with Provider Services is responsible for the overall development and management of IEHP’s Provider network, contracting, compliance, and Provider oriented projects, initiatives and data analysis. 
This includes:
- Providing guidance and oversight of Provider Contracting and Strategic Relationships.  Working in collaboration with the Provider Network team to ensure network adequacy in geographical areas in compliance with regulatory requirements and IEHP strategies.
- Developing, leading and aligning the execution of both short-term tactical initiatives and long- term strategies. 
- Integrating Provider network plans, activities, programs, policies and initiatives throughout IEHP. 
- Exemplifying insight, innovation and leadership to drive multiple strategies resulting in effectively managing medical benefit costs while continuously improving quality, access and Member satisfaction.

Major Functions (Duties and Responsibilities)

 

1. Lead the functions in Plan Management and Provider Contracting and Services strategies to support Plan operations and initiatives.
2. Develop directly contracted PCP network contracting protocols.
3. Prepare and negotiate all contracts in collaboration with the Chief Financial Officer and Chief Network Officer to ensure the terms of the contracts are fulfilled and health plan economics are maintained.  
4. Oversee  financial  and  operational  reviews  of  contracted  entities, in partnership with the Chief Network Officer, develop  corrective action plans including input to claims, audits, policies and procedures, fiscal viability audits, and contract compliance issues, implementing initiatives and strategies to control medical costs in order to achieve budgeted  medical cost targets; support state-of-the-art Provider contracts which incorporate the principles of performance accountability, effective medical management strategies, use of  health information technology systems  and implementation of a process of continuous improvement in care delivery.   
5. Lead provider contracting team and partner with the Provider Network and Utilization Management teams to identify and recruit providers based on network composition and needs.  Work with the Provider Relations team to improve servicing activities for business expansion in new and existing geographic service areas.  Work in concert with Provider Relations team to develop and implement strategies to strengthen and/or develop new physician, hospital and other Network Providers. 
6. Incorporate new, innovative, emerging and/or effective quality and benefit cost control programs to improve the delivery of high quality and cost-effective care for IEHP’s Members.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Minimum seven (7) years of experience of relevant contract execution, negotiation and implementation, network and strategy development, leadership experience in a managed care setting (HMO, IPA/ Medical Group or equivalent) at a Senior Leadership level.
Commercial Contracting experience is requied.  Experience working closely and effectively with physicians, hospitals, and other healthcare providers, with a preference for experience in integrated delivery systems.
Demonstrated or equivalent experience in leading all aspects of provider network activities, including network development, value based contracting strategies and negotiations, and provider servicing and relations which will facilitate the creation and maintenance of a high performing, accountable and engaged provider network.    

Education Qualifications

 

Bachelor's degree in a related field from an accredited institution required.

Preferred Education

 

Master’s degree in a related field from an accredited institution strongly preferred

Drivers License Required

Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement

 

Demonstrated financial acumen and experience using medical cost and other data and information as the basis for making sound decisions in contracting, as well as in the delivery of medical management, quality management and related improvement programs. 
Understanding of the financial implications, while ensuring legal and regulatory compliance.
Understanding of Medical Loss Ratio (MLR) cost drivers and a demonstrated success in managing the medical cost component of the MLR.
Understanding of the business environment and community, as well as trends and issues which will, or could potentially, influence the organization’s business performance.

Skills Requirement

 

A strong leader with proven ability to identify the need for change, anticipating, recognizing and creatively addressing resistance to change; working with others to view change as a challenge and opportunity for growth. 
Proven ability to attract, build, mentor and direct a high-performing cohesive and well-integrated team.
Proven track record in building successful relationships in a variety of contexts.
Successful execution of innovative and effective ideas and strategies.

Abilities Requirement

 

Strategic influencer who drives agreement through intellect, interpersonal and negotiation skills. 

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

 

Starting Salary: $227,052.80  - $312,187.20  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles