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Job Summary

This role will be responsible for developing and driving market strategy and ensuring excellence in programs, Stars, risk adjustment, total cost of care, and provider relationships. The ED will continue to strengthen partnerships with providers and health systems in the covered Markets, working closely with Independent Physician Associations (IPA), health systems, aligned managed service organizations (MSO) and independent practices, and managing a team of provider performance enablement professionals to drive quality and performance initiatives.

*Please note: This is a Telecommute (Remote) role supporting the North East region. Remote employees must live within the continental United States, excluding Alaska, California, Hawaii or New York. Sponsorship is not available.

Key job responsibilities include but are not limited to:

• Communication. The ED will be a conduit of communication for all aspects of the business between the Northeast Region and matrix partners including, but not limited to: national vendor contracts, value based contracting, clinical review services, clinical programs, population health management, Stars, risk adjustment, Finance, affordability and network operations.
• Strategy. The ED will partner closely with the Market Medical Director and provider performance enablement team to develop and implement market strategies for performance in Stars, clinical documentation/risk adjustment and total cost of care. The ED will prepare a monthly market report.
• Contracts. ED will support Contracting/Provider Relations with market contract reviews, settlements, and issues raised by providers over claims.
• Provider engagement. ED will be a key leader in preparing and conducting provider performance meetings with provider partners with select key provider systems; they will strive to form and strengthen relationships with provider partners and improve their performance for the MA plan.
• National projects / initiatives. The ED will help implement national initiatives with market level impact when an opportunity is identified. The ED will also participate in national committee/work groups positions as appropriate.
• Responsible for local MA Provider network development and management, with focus on driving performance metrics. Drive engagement with provider partners and advance our Value Based Care efforts in the markets.

Required Job Qualifications:

• Degree in health administration, business administration, or another related field (MBA desirable) and/or 15 years of experience with 12 years in a progressively responsible leadership role focused on managed Medicare and provider engagement.

• Demonstrated results in being able to think strategically, anticipate future consequences and trends, and incorporate them into both a short-term and long-term organizational plan.

• Strong influencing and negotiation skills, contracting and network savvy, business owner mindset and ability to successfully lead in an ambiguous and changing market with the evolution of healthcare reform, collaborative care and delivery system alliance development and expansion, and the need for governmental influence and savvy.

• Effective communicator to executive level staff and external audiences balanced with strong interpersonal skills.

• Experience building strong and authentic relationships with large health systems and provider groups.

• Creative problem solving and analytical thinking with a perspective of our provider partners and customers. 

• Experience in business management with responsibility for day-to-day management of short and long-term goals and objectives, health care expenditures, department budgets, and human resource management. 

•  Enterprise thinker with proven ability to influence across a matrix environment. Ability to develop relationships across all levels of the organization, as well as externally.

• Capable of effectively messaging detailed value propositions to key stakeholders that blends operational know how and technical skills with market savvy and vision/strategy.

• 35-50% of local travel required.

Preferred Job Qualifications:

• Leader from a large, complex managed care organization or provider system with an innovative risk oriented capability with a proven ability to lead a portfolio of markets or business units that is both analytical and customer oriented from a strategic and operational perspective.

• Ability to assume broader organizational responsibilities as warranted. 

• A team player with experience in complex matrix environments with the ability to build consensus among divergent interests and competing organizational needs.

• Demonstrated ability to manage complex systems and change management across a large organization.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$177,500.00 - $329,800.00

Exact compensation may vary based on skills, experience, and location.