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Jobs Available: VP - Health Care Management Services & VP - Provider Relations

For more details about these opportunities, contact Katie Coleman, Solutions Delivery Coordinator at Catalyst Solutions.  Candidate identification closes in a few days, so don't delay!

Main: 1-800-903-9574 | Office: 303-603-3211 | Website: www.catalystsolutions.com

VP of Health Care Management Services (Virginia Beach, VA)

Responsible for understanding functional area of responsibility and how the functional areas interrelate, gathering requirements, performing analysis, supporting the development and testing processes, and understanding the applications, data, and associated technologies for supported areas. Support departmental methodologies and provide input for improvement to tools and processes. Provide leadership within the team, department, and organization by chairing meetings, writing and executing test plans, and coordinating with business owners.
The preferred candidate will have the following experience:
  • Perform detailed requirements gathering, analysis, and process and data flow diagramming for processes of moderate complexity
  • Exhibits Project Management skills including development, maintenance and management of a detailed project plan, RACI matrices, resource leveling and budget management
  • Understands and considers the relationship between processes
  • Able to identify risks and multiple solutions
  • Can contribute to analysis standards
  • Utilize appropriate methods to resolve moderately complex design issues
  • Able to perform complex SQL queries
  • Understands data modeling concepts and their application: entities and tables, relations and constraints, attribute data types and column data types
  • Working knowledge of moderately complex database design
  • Writes, revises, and verifies test plans for complex systems
  • Evaluate and test complex new/modified programs and applications
  • Monitor system functionality and performance to ensure standards are met
  • Document and track product defects
  • Coordinate problem resolution with development and/or product vendors
  • Requires little assistance and supervision
  • Demonstrates an understanding of moderately complex license and support agreements to ensure compliance and requirements are met
  • Uses SDLC development methods or industry best practices under limited supervision
  • Demonstrates the ability to validate proposed contracts meet requirements
  • Managed care experience with in-depth knowledge of claims, provider, and member files

The Preferred Candidate Demonstrates:
  • Familiarity with Functional Decomposition and/or Object Oriented analysis techniques and related diagrams (Use case/Context/Process Decomposition/Sequence/etc.).
  • Previous experience with system conversion including transaction system conversion
  • A basic knowledge of current technology trends
  • Provides software testing assistance and training to less experienced team members
  • Skills in reviewing and guiding analysis efforts of others
  • Ability to assist in setting analysis standards
  • An understanding of financial arrangements and impact as it applies to the budget
  • Ability to develop creative strategies and tap the creative potential of individuals and groups.
  • Ability to continually assess needs and implement measures to ensure customer expectations are met or exceeded.
  • Ability to turn problems into opportunities for change.
  • Advanced proficiency with all applicable company supported software applications.
  • An ability to apply configuration knowledge to resolve basic to moderate business issues, identify alternatives, determine impact, and recommend optimal configuration solutions.
  • A comprehensive understanding of how each department/health plan relates to the organization as a whole.
  • Able to direct, lead, and coach a team. Able to resolve team conflicts.
  • Able to develop and manage multiple projects with minimal direction and supervision.
  • Manage small project related budgets.
  • Motivate others and provide innovative ideas and solutions, and promote the department vision for improvement and integrate that vision with others in the organization
  • Develop short range plans to accomplish specific goals given a set amount of resources and set timeframes .
VP of Provider Relations (Virginia Beach, VA)

Responsible for providing the Health Plan with an overall expertise in physician, physician group, hospital and ancillary healthcare contracting and provider reimbursement methodologies, taking the lead on Provider Relations projects in existing, expansion and new markets. Responsible for developing contracting and financial strategies, executing strategies, and maintaining positive provider relationships while advancing the goals of the Health Plan. Responsible for oversight of all Provider Relations staff and all provider contracting and servicing activities, including resolution of complex operational issues impacting provider relationships.
PRIMARY RESPONSIBILITIES:
  • Effectively represent client in interaction and negotiation with the most senior clinical and administrative executives.
  • Collaborate with the CEO/COO and other Health Plan senior management to determine the Plan’s provider contracting needs.
  • Lead the development of provider network business plans, strategies and goals as they relate to network expansion and provider contracting, education, communication, policies, procedures and servicing.
  • Lead the development of provider network related earnings improvement initiatives as well as network growth and expansion initiatives.
  • Develop and implement Provider Relations projects or assignments in support of Health Plan goals and the Home Office.
The successful candidate will be managing 25 people total including the AVP of Hospital Contracting along with several directors. The VP will own Provider Contracting, will strategize around hospital contracts. They should have a Medicaid background as Amerigroup is a Medicaid plan. In addition to contracting responsibility, they will need to deliver on a service model to providers. They will be running operations (ex: investigating why a provider is not getting paid). They will also be teaching the staff how to service providers (including hospitals, physician groups, and ancillaries). They should be familiar with key reimbursement methodologies including Capitation, DRG, Fee-For-Service (FFS), and medical homes. The challenges for this role is putting together a tight team for physician contracting, they will also be preparing for a big bid on Medicaid business in Florida in 2013.

The fine print: I post interesting executive-level and strategy-related job opportunities as they come to my attention. These are not my searches. I am not a recruiter and have no stake, financial or otherwise, in filling the position, just a hope that, in some small way, I can assist you, dear reader, in finding your dream opportunity.

Connect with me on Twitter.  I'm @whatifwhynot

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