The RequirementsTo be a good fit for this opportunity you will have:
- A bachelor's degree in Business or a health related discipline (such as Health Care Administration, Finance or Management) or equivalent business experience. A master's is preferred.
- 10 years of relevant experience in a managed care environment with exposure to large integrated delivery systems.
Experience and comfort contracting with:
- Government programs.
- National hospitals systems and vendors.
- Providers with multiple products (i.e., Medicare, Medicaid, long term care, integrated dual eligible products, etc.).
- A proven track record of success in network development and a solid understanding of health care finance.
- Demonstrated success in directing the activities of others, managing operational and strategic organizational change, forming collaborative relationships at all levels, from staff to executives.
- Experience in a leadership position.
- Medicaid Managed Care and/or Medicare Advantage experience.
- Experience working across lines of business (or on a national level).
- Experience in a company with multiple lines of business.
- Proficiency with Microsoft Office Suite software including Word, Excel, PowerPoint, etc.
- The ability to effectively establish priorities and set long-term goals.
- Strong influencing, negotiation and decision-making skills.
- Autonomy and the ability to work in a fast paced, rapidly changing environment.
- The ability to build strong internal and external relationships and represent the mission and values of the company.
The RoleReporting to the VP, Corporate Provider Network, as the Director, Corporate Network Development and National Contracting you will be responsible for developing the provider strategy in new markets and effectively communicating the strategy to your team to carry out and implement. You'll leverage your proven leadership skills to oversee a team of approximately 15 professionals, with 5 of these team members reporting directly into you. It will be your job to provide the necessary support and resources to ensure the strategy is accomplished.
You will focus on network development for new markets and products, where you'll be charged with establishing partnerships and obtaining contracts with ancillary providers and vendors that are cost effective and high quality. This will include national hospitals, major health systems, laboratories, and more. Provider Network Management is a collaborative, cross-functional group, where each member of the team strives to keep key players in the loop on current strategy or project development. In addition to your work within this group, you can also expect to regularly collaborate with Finance, Legal and a variety of other internal departments.
More specifically, you will:
- In conjunction with appropriate representatives from Corporate IT, Informatics, Operations, Medical Management and individual Plan functions, manage the process for selecting national providers relating to Network Management products and services. The process includes but is not limited to developing/issuing the RFP, selecting vendors and implementing the contracts. You will ensure that all stakeholders are informed and their interests represented.
- Organize and lead the PNM organization efforts in evaluating new business development opportunities and activities in new business activation. Provide guidance regarding, and ensure consistency with corporate standards and processes for PNM structure, development, management and maintenance.
- Provide similar leadership for new product development evaluation and activation in existing business.
- Provide leadership in evaluating and standardizing PNM team structures across the enterprise to ensure alignment with established enterprise processes, systems, points of reference (definitions) and metrics. Continuously evaluate and recommend possible structures to respond to changing market needs. Ensure enterprise and Plan evaluation and implementation of structural changes.
- Implement standardized processes, systems, points of reference (definitions) and metrics in new markets to include but not limited to: network management organizations structure, policies and processes, provider communication and provider services.
- In conjunction with Corporate Medical Economics and collaborating with Plan PNM representatives, identify the need for and develop tracking mechanisms/reports to analyze enterprise PNM performance and/or opportunities for improvement.
- Monitor relevant data to proactively identify problems or opportunities for change.
Why AmeriHealthCareer options -- strong growth + visible role + your results orientation = opportunity. We're looking for executive talent to help lead us to the next level and beyond. Once you've proven yourself in this role you might set your sights on a promotion or follow a completely different path within the company.
Great time to join -- the AmeriHealth Mercy Family of Companies is undergoing a major growth initiative. As our CEO likes to say, AMFC is poised to become even more of a national player as we "advance from Division 2 to Division 1 status." In pursuit of this goal, we're building a new business development / implementation team as we deepen our presence, and you'll be part of this expansion initiative from the beginning, making your mark and building provider networks.
Award winning, high quality products -- AmeriHealth offers quality health care products and services designed specifically to meet the changing health care needs and high expectations of our customers. Keystone Mercy Health Plan and Select Health of South Carolina, for instance, have received the highest possible accreditation by the national leader in HMO quality evaluation. The National Committee for Quality Assurance has awarded both HMOs "Excellent" status for meeting its rigorous evaluation standards.
Expansion through visionary leadership -- under the leadership of Michael A. Rashid, President and CEO of the AmeriHealth Mercy Family of Companies, the company has embraced an ambitious strategy to build the reserves and infrastructure needed to achieve market leadership over the next five years. Rashid's Vision is that by 2015 AMFC will be recognized as the national leader in developing healthcare solutions for the chronically ill and the underserved.
A special mission of care and focus -- Sister Renee Yann, of the Sisters of Mercy, is Senior Vice President and Chief Mission Integration Officer for AMFC, responsible for mission integration across the organization. Our mission:
- We help people get care, stay well, and build healthy communities.
- We have a special concern for those who are poor.
Keys to SuccessTo excel in this role, you should have a passion for your work and a drive for results. This is a high profile role, where you'll be working directly with executives, hospital officials and other key stakeholders, meaning your influencing skills and ability to build relationships based on trust will be key to your success.
Additionally in order to be an outstanding Director, Corporate Network Development and National Contracting, you will have a high level of integrity and strategic thinking. You should also maintain an in-depth understanding of:
- The Enterprise growth plan and State requirements related to network development and provider requirements.
- The Enterprise's strategic direction, immediate focus and business developments.
- The operational components for implementing national provider contracts.
About UsThe AmeriHealth Mercy Family of Companies (AMFC) is one of the nation's leaders in health care solutions for the underserved. AMFC operates in 12 states (and growing) and serves more than four million Medicaid, Medicare and SCHIP members through its Medicaid managed care products, pharmaceutical benefit management services, behavioral health services and other administrative services. Headquartered in Philadelphia, AMFC is a mission-driven company with nearly 30 years of experience serving low-income and chronically ill populations. AMFC's core products include full-risk HMOs, management contracts, administrative services, pharmacy benefit management, care management services and behavioral health care management services.
AMFC owns and operates four full-risk Medicaid managed care plans: AmeriHealth Mercy Health Plan (Harrisburg, PA); Keystone Mercy Health Plan (Philadelphia, PA); LaCare (Baton Rouge, LA); and Select Health, Inc. (Charleston, SC). Our extensive experience with Medicaid TANF and SSI populations makes us a leader in voluntary and mandatory Medicaid markets.
Our service is built on these values:
- Care of the Poor