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Vice President, Network Development & Contracting

Role overview

Qualifications

  • Bachelor's Degree or equivalent experience in Business Administration, Healthcare Administration or related field
  • MBA or MHA degree preferred
  • 10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment
  • Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff

Responsibilities

  • Direct the provider network and contracting activities; lead all aspects of network strategy including access analysis, network operations and provide analysis related to reimbursement and unit cost management; oversee coordination and negotiation for the contracting department
  • Establish the contracting 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 developing provider networks across expansion markets; perform periodic analyses of the provider network from cost, coverage, and growth perspectives; evaluate opportunities to expand or change the network to meet company goals
  • Manage budgeting and forecasting initiatives for product lines to network costs and provider contracts; oversee analysis of claim trend data and market information to support contract negotiations; conduct periodic review of provider contracting rates and support market expansion and MA activities through due diligence; assist health plan CEO/COO vendors in key provider relations and strategy

About the company

Centene Corporation logo

Centene Corporation

Health Insurance (Payers)

Centene Corporation provides high-quality healthcare services to members in all 50 states. Since its founding in 1984, Centene has worked to transform the health of communities, one person at a time. Centene is the largest Medicaid managed care organization in the country and provides a portfolio of services to government sponsored healthcare programs. Centene believes that healthcare is best delivered locally. Our local health plans offer a range of health insurance solutions with a focus on providing accessible care to uninsured and under-insured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans). Centene also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services. Centene’s hiring practices reflect the composition of the members and communities we serve, allowing us to deliver quality, culturally sensitive healthcare to millions of members. Centene employees help change the world of healthcare and transform our communities. To learn more about career opportunities with Centene, visit: https://jobs.centene.com/

Company details

Company typeXLarge
IndustryHealth Insurance (Payers)
Company size10001

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Job description

Centene is transforming the health of our communities one person at a time.  As an Executive on our team, you could be the one who changes everything for our 28 million members.
 

Position Purpose: Direct the provider network and contracting activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the contracting department.
  • 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 cost, coverage, and growth perspective.
  • Provide leadership in evaluating opportunities to expand or change the network to meet Company goals.
  • Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts.
  • Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.
  • Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy.
  • Support market expansion and M&A activities by leading provider contract analysis related to due diligence.
  • Assist health plan CEO and/or COO vendors in key provider relations and strategy.
  • Ability to travel.

Education/Experience: Bachelor's Degree or equivalent experience in Business Administration, Healthcare Administration or related field required.
MBA or MHA degree preferred.
10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment required.
Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

Pay Range: $180,400.00 - $343,300.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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