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RVP I Provider Solutions - PS27915

Provider Network Management
PS27915 Requisition #

 This position is located in CA. Candidate must reside in CA.


This is a California State wide position!   


Responsible for providing strategic leadership for provider engagement and contracting for assigned state with a benefit spend between $3 billion and $8 billion, including local cost of care and trend management, provider contracting, implementation and local oversight of all types of payment innovation programs, and provider relations and education.

Primary duties may include, but are not limited to:

  1. Delivers competitive cost of care trends in assigned state.
  2. Develops provider networks that provide a competitive advantage.
  3. Aligns contracting strategy with medical management strategy.
  4. Integrates quality metrics and incentives into contracting process.
  5. Serves as Provider Solutions local single point of accountability for all product lines and is the state lead for the Integrated Cost Management (ICM) committee.
  6. Facilitates the implementation of local system and product consolidation efforts.
  7. Ensures compliance with regulatory and accreditation standards.
  8. Collaborates with Product Development to recommend and implement innovative benefit plan designs.
  9. Hires, trains, coaches, counsels, and evaluates performance of direct reports.
 Hiring Manager’s Preferred Skill-Sets:
  • Develop, create and implement a Network Development strategies and processes across all lines of Commercial and Government business while responding to changing market dynamics and needs of key stakeholders and cross-functional partners, with a heavy emphasis on market growth and expansion opportunities.

  • Assess and adjust strategic plans in the context of overall corporate direction, financial targets, and market needs.

  • Lead large scale, complex network strategy projects that are cross-organizational in nature.

  • Provide direction and guidance on Network Development strategies, opportunities, challenges, risks, results and outcomes to executive leadership on an ongoing basis. 

  • Hire, train, coach, counsel and evaluate performance of direct reports.

  • Coordinate activities cross-organization to ensure alignment between Network Development efforts and the California and corporate strategies and directives.

  • Requires BS/BA in business administration or related healthcare field.
  • 8+ years of experience in healthcare operations, finance, underwriting, actuary, network development and/or sales.
  • Any combination of education and experience, which would provide an equivalent background.
  • MBA preferred.

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