Associate Vice President, Provider Relations(Must Live In Ohio)

Informs decision-making around payer and provider best practices related to innovating, supporting, and empowering providers in the pursuit of delivering person-centered and high-quality care to members. Oversees CareSource’s strategic design, implementation, and evaluation of provider contracting, network, and relations to proactively support provider engagement and operational performance.

Responsibilities

• Lead Ohio Department of Medicaid (ODM) contractual requirements, such as Network Development Management Plan (NDMP), Network adequacy, Provider Engagement, and Education.
• Oversee Provider’s operational strategy for Ohio, ensuring evaluation and outcomes align across senior leaders to ensure measurable provider contracting, network, and relations as part of a cohesive data-informed strategy that meets overall quality, financial, and compliance requirements with State and Federal regulations.
• Oversee collaboration with market and enterprise workgroups to ensure alignment and implementation of Ohio strategy, including committees such as Provider Advisory Committee, NDMP Committee, Enterprise Provider Reimbursement Committee, MCA Committee, and others as needed.
• Represent Ohio Market Leadership as a panelist and subject matter expert.
• Collaborate with the Ohio Executive team to ensure provider contracting and engagement performance aligns with CareSource enterprise and Market strategies, contractual, policy, and state/federal programs.
• Build, maintain, and improve structures and processes to assure impeccable regulatory records, achievement of goals, and consistency from market-to-market and product-to-product.
• Collaborate, innovate, and support provider approaches to address contract compliance, industry-supported contract requirements, and financial alignment.
• Coordinate and collaborate with providers, local and state government, community-based organizations, Ohio Department of Medicaid (ODM), and other ODM-contracted managed care entities to support a strong provider network.
• Ensure efforts to improve provider engagement, satisfaction, and contractual performance are designed collaboratively with other ODM and ODM-contracted managed care entities to create collective impact for the population, incorporating lessons learned into future decision-making.
• Collaborate with Enterprise and Market leadership on the development of overall program strategy and business objectives related to Providers.
• Foster external and internal intra/inter-departmental relationships with hospitals, physicians, community agencies, trade associations, and key vendors.
• Collaborate with Provider Relations and Community Stakeholders to facilitate access, address barriers to care, and improve coordination that supports healthcare outcomes.
• Develop health plan Network policies, procedures, and goals to align with market requirements and CareSource strategy/model.
• Ensure budget and financial goals are set in conjunction with the Ohio Market executive team.
• Monitor health plan Network budgets; describe variance detail monthly with effective action plans.
• In collaboration with the Consumer Experience Team, monitor and analyze member satisfaction surveys to identify and develop appropriate action plans with reporting activities as needed.
• Produce team results demonstrating engagement rates, low Grievances & Appeals, Continuous Improvement, Human Capital metrics that show leadership behavior supports improved outcomes, positive culture, and consumer experience.
• Develop and maintain an in-depth knowledge of the company’s business, regulatory environments, and high-level Health plan knowledge.
• Consult across Markets to engage in collaborative improvement activities including program planning, analytic review, and communication.
• Perform any other job duties as requested.

Requirements

• Bachelor of Science/Arts Degree or equivalent years of relevant work experience is required.
• Master’s degree in business or healthcare preferred.
• A minimum of ten (10) years of experience in healthcare external stakeholder and community program support, project and program management, complex business processes, strategic and business planning, or related field.
• A minimum of three (3) years of prior management experience.

Skills

• Proficient in Microsoft Excel, Word, PowerPoint, and Outlook.
• Critical listening and systematic thinking skills.
• Planning, problem identification, and resolution skills.
• Business process/management skills.
• Strong financial background.
• Ability to maintain confidentiality and act in the company’s best interest.
• Strong oral, written, and interpersonal communication skills.
• Excellent leadership, management, and supervisory skills and experience.
• Energetic, enthusiastic, and politically astute.
• Ability to act with diplomacy and sensitivity to cultural diversity.
• Responsive to a changing environment.
• Strategic deployment and management skills.
• Conflict resolution skills.
• Knowledge of regulatory reporting and compliance requirements.
• Proficiency with provider engagement, performance improvement, and operations.
• Ability to work with multi-disciplinary departments across the organization.
• Demonstrated ability to develop, prioritize, and accomplish goals.
• Strong interpersonal skills and high level of professionalism.
• Ability to work independently and within a team environment.

Licensure and Certification

• Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employment has started, it will be terminated.
• Influenza vaccination is required annually (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and verify immunization records.
• CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position.

Schedule

• General office environment; may be required to sit/stand for long periods of time.
• Travel may be required 25% to 50% of the time to perform work duties; a valid driver’s license, car, and automobile insurance are necessary for work-related travel.

Pay

$150,000 - $300,000. Salary is determined by a combination of a candidate’s education, training, and experience, as well as the position’s scope and complexity, discretion, and latitude required for the role, and other external and internal data. In addition to base compensation, you may qualify for a bonus tied to company and individual performance.

Benefits

CareSource offers a substantial and comprehensive total rewards package.