Chief Provider Network Strategist – Great Leadership Role – Growth and Expansion with Mass. Payer!

US-MA-Worcester

Job ID: 6717
Type: Full Time
# of Openings: 1
Category: Network Development
Fallon Health – Corp HQ

Overview

About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Summary:
Use expertise and proven leadership skills to drive an enterprise-wide effort to define and execute on a provider network strategy that aligns with Fallon Health’s corporate strategy. Oversee operational and contracting activities to support product line goals. Innovate and drive quality/competitive value-based risk contracting. Mission driven and passionate about and aligning value-based care with value based payment models.

Responsibilities

• Maintain a strong external presence amongst our key network partners.
• Lead network development and contracting as well as provider relations teams.
• Explore opportunities to expand or change the network to meet company goals.
• Perform periodic analyses of the provider network from a strategic, cost, coverage and growth perspective.
• Partner closely with product line leaders to formulate individual product network strategy, ensuring strategic focus is on target with overall company strategy.
• Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.
• Support market expansion activities by leading provider contract analysis related to due diligence.
• Establish contracting fundamentals – ensure the structure and responsibilities are properly aligned.
• Drive quality and competitive standards throughout all Network Development Management and Provider Relations initiatives.

Qualifications

• Bachelor’s degree required; Master’s degree (MBA, MPH, MPA) preferred.
• Minimum 15-20 years of experience in healthcare management with a thorough understanding of the healthcare market and the business needs of healthcare providers.
• Proven track record of achieving goals and delivering bottom line results.
• Extensive experience with managed care contracting including the fundamentals of contract design, variations in provider compensation arrangements including capitation and knowledge of hospital reimbursement.
• Value based risk contracting and population health, risk adjustment, data and reporting as well as operations knowledge.
• Experience with advanced financial and analytic models.
• Strong depth of knowledge in government program contracting, with a particular expertise in Massachusetts Medicaid and Medicare populations/product lines required.
• Strategic experience managing/understanding large provider networks in a highly competitive marketplace.
• Broad knowledge of the financial and strategic impact of provider contracts and network affiliations in the healthcare space.

Additional experience/qualities:

• A thoughtful innovator needed to energize and invigorate the network both internally and externally – a change agent.
• Ability to recruit and build an effective network team.
• Demonstrated success at building/fostering provider relationships.
• Superior interpersonal and negotiation skills.
• Demonstrated ability to communicate effectively and influence physician leaders and high-level hospital administrators as well as a keen understanding and respect for the providers’ needs

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022, all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

JT18