Providence is calling a Vice President of Contracting and Network Development to Providence St. Joseph Health System in Irvine, CA.
This system-wide role is responsible for managing provider Contracting and network development for the medical groups across Providence St. Joseph Health System (PSJH). The Vice President of Contracting and Network Development is responsible for contract development, execution, and management for contracts between PSJH's medical groups and the respective payers, purchasers, and provider groups. This position supervises two Directors, one accountable for managing a team that does the contracting on behalf of St. Joseph Heritage Medical Group and its affiliates and the second for Providence Medical Institute and its affiliates, including Providence Medical Group, Axminster, Providence Care Network. This position will serve as the Vice President for Contracting for California in order to facilitate a single-point of contact for our key payers and stakeholders in the California markets. There are three regions within PSJH in California: Northern CA, LA County, Orange County/ High Desert. In partnership with the VP of Payer Contracting, VP of Contracting and Network Development will maintain strong relationships between the payers, PSJH and the providers affiliated with the system. The position will work closely with the leaders of each medical group and network, as well as the system leadership to ensure the contracts developed meet our patient care goals. The position is expected to perform all duties in a manner that reflects the PSJH mission and philosophy with a strong commitment to serving the poor and the vulnerable.
In this position you will:
Provide internal and external strategic direction for PSJH at the system and regional level regarding provider contracting and network development, specifically in a largely capitated environment such as California.
Develop aligned relationships with the Medical group leadership, Regional leadership, and system leadership.
Advise system management in the overall direction for provider contracting and network development
Responsible for developing and recommending strategic contract initiatives, desirable reimbursement methodologies and other arrangements that drive incremental volume, profitability and value.
Participates as needed in the negotiation and implementation of national and large regional contracts for our network providers.
Thought leader regarding network management and value creation for the system.
Research and prepare organization in collaboration with applicable functional leaders, for federal/state health reform, plus regulatory issues in relation to health benefits, payer products and reimbursement methodologies
Evaluate financial reports, contract terms and conditions, and other data points required to fully execute a provider agreement.
In partnership with the VP of Contracting and Payer Relations works to develop strong relationships and partnerships with key payers to advance PSJH goals of managing the health of our population.
Develop innovative risk sharing arrangements that increase opportunities for revenue growth and reward for appropriate management of total cost of a population
Represent PSJH in the community and with regional leadership
Develop pricing methodologies in support of new programs or clinical business planning (i.e. bundles, centers of excellence, etc.) that align with our quality and performance goals as a system
Educate leadership on emerging models of care and collaborate with appropriate system leadership to ensure development of the clinical, financial and operational infrastructure necessary to be successful in these new models of care.
Report on performance in the new models of care, so the future of these models can be evaluated effectively.
Provide strategic financial direction in support of key strategic initiatives for long-range financial planning, capital expenditures and budgeting.
Participate as leader on key system, medical group or board level committees, such as St. Joseph Heritage Provider Contracting Committee, PSJH Clinical Committee, or Providence Health System Medical Group Committees.
Participate on an executive level with healthcare associations and other local, state or national stakeholder groups, as appropriate.
Serve as the VP of Contracting and Network Development for PSJH in all regions, with direct accountability for California's contracting goals.
Serve as the supervisor for the contracting team located in the California region, including executive directors, contract managers, specialists, analysts, etc.
Required qualifications for this position include:
Bachelor's degree required, preferably in healthcare administration, finance, business, or related field.
Master's degree in Business Administration (MBA), Health Administration (MHA) (or equivalent experience) required [Other advanced degrees may be considered depending on years of experience – JD, Ph.D., MD].
Minimum ten years of experience in health care.
Minimum 7 years of leadership experience with accountability for managing a team.
Extensive experience leading high profile contract negotiations, business planning and strategic execution of initiatives.
Minimum five years of experience working in a managed care environment on either the payer or provider side with experience in large capitated environments.
Experience with managing provider contracts in California or a state with a similar regulatory environment (e.g. Corporate Practice of Medicine law; Managed Medicaid; Patient Privacy Regulations and Policies).
Providence St. Joseph Health was established on July 1, 2016, creating the second largest Catholic health system and fourth largest non-profit integrated delivery system in the country, which provides a broad range of health and outreach services throughout the western United States. With total revenues exceeding $20 billion in fiscal year 2015, the health system family includes 50 acute care hospitals as well as home health agencies, hospice care, outpatient services, skilled nursing facilities, insurance plans and physician organizations. Providence St. Joseph Health includes more than 100,000 caregivers, 829 outpatient clinics, 23,000 physicians, across seven states. The system has 1.9 million covered lives.
The Providence St. Joseph Health family includes:
Providence Health & Services
St. Joseph Health
Covenant Health in West Texas
Facey Medical Foundation in Los Angeles
Hoag Memorial Presbyterian in Orange County, California.
Kadlec in Southeast Washington
Pacific Medical Centers in Seattle
Swedish Health Services in Seattle
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.