Fallon Health Vice President, Provider Contracting / Network Development - Growing Managed Care Co.! in Worcester, Massachusetts

Overview

THE OPPORTUNITY:

Fallon Health has an exciting opportunity for a Vice President, Contracting reporting to our new Senior Vice President of Strategy and Business Development. We are looking for a strong leader with deep expertise in both Provider Contracting and Network Management. In addition to relevant experience, we are looking for a collaborative and strategic thinker to support Fallon Health as we expand our partnerships with providers across the state.

The Vice President, Contracting will have the support of a strong team and will benefit from the Senior Vice President, Strategy and Business Development’s contemporary leadership style as she fosters teamwork, respect, collaboration, autonomy, innovation, and process improvements. In this role, the Vice President, Contracting will be closely aligned with Fallon Health’s product line leaders across the entire portfolio of products and will have the ability to influence core business strategy and future initiatives.

It is a great time to join Fallon Health with our membership is at a record high, three exciting ACO partnerships, and a strong future ahead.

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.

Responsibilities

SUMMARY:

Lead enterprise wide effort to define the provider network strategy in alignment with Fallon Health’s corporate strategy. Oversee operational and contracting activities to support product line goals. Use expertise and proven leadership skills to expand existing capabilities including negotiation, analysis and service.

Responsibilities

  • Establish the department’s strategic vision, objectives, and policies and procedures.

  • Develop, implement and maintain production and quality standards for the Contracting department.

  • Oversee network development staff and external consultants in the development of provider networks across expansion markets.

  • Perform periodic analyses of the provider network from a strategic, cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet Fallon Health goals.

  • Partner closely with product line leaders to formulate individual product network strategy in addition to alignment with larger organizational strategy.

  • Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.

  • Conduct regular reviews of provider contracting rates to ensure strategic focus is on target with overall Fallon Health strategy.

  • Support market expansion and M&A activities by leading provider contract analysis related to due diligence.

  • Oversee and drive improvement to industry standard pricing and reserving method.

Qualifications

Education:

BS or BA required, MBA preferred

Experience

  • Minimum 10 years of experience in healthcare management with a thorough understanding of the healthcare market and the needs/concerns of healthcare providers.

  • Requires deep experience with managed care contracting including the fundamentals of contract design, variations in provider compensation arrangements including capitation, and knowledge of hospital reimbursement.

  • Requires experience with advanced financial and analytic models. Must have a demonstrated ability to communicate effectively with physician leaders and high-level hospital administrators. Requires excellent negotiation skills.

  • The selected leader must have the ability to lead Fallon Health’s Network Development & Management function through professional qualifications and leadership skills, and must project the highest levels of integrity and respect. Superior interpersonal skills are required.

JT18

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Job ID 5274

# Positions 1

Category Network Development