Director, Regional Network and Provider Relations Lead

It?s Time For A Change? Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
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Encouraged by the success of provider-led health plans in other states in improving health care quality and lowering costs, Evolent Health is working together with Lee Health to support Vivida Health Plan . Vivida intends to meet the Agency for Health Care Administration objectives to drive similar outcomes for Florida Medicaid members locally in Region 8, which includes Sarasota, De Soto, Charlotte, Glades, Lee, Hendry, and Collier counties. Evolent?s clinical, financial, and operational resources will enable the innovation and infrastructure needed for the immediate launch and scale of Vivida. Evolent Health is proud to support AHCA and Vivida?s mission: _Vivida Health connects you with the care and community services you need. We are local doctors helping you and your family stay healthy so you can focus on what?s truly important:_ _each other_ _._
What you'll be Doing:
The role will have a strong emphasis on hospital, physician and ancillary provider contracting, maintaining network adequacy and required network regulatory compliance, RFP/ITN response, assisting risk partners in managing value based agreements with financial risk and provider onboarding, education and training. Regarding the latter, the role will develop strong interpersonal relationships with contracted physicians and hospitals in support of provider driven health plan; at both the outset and expansion of the relationship. The candidate will be expected to keep abreast of local market trends and performance data to manage medical cost trends and develop strategies to keep the trend down. The Director will also work closely with Health Plan Medical Directors to develop physician education programs and to support the development of financial incentives related to improvements in coding.
The candidate should have the ability to continuously interact effectively with other Health Plan and Evolent departments; sometimes in a matrix reporting responsibility. The role will also initiate and maintain effective working relationship with TPA provider services, medical management and sales and marketing departments.
Additionally, the Director of Network Development will have the opportunity to shape team culture and operating norms as a result of the fast-paced nature of a new, high-growth entity.
This role must live in a FL Medicaid Region in which the Health Plan Operates. This is not a remote role.
All other duties assigned by manager and supervisor.
The Experience You'll Need (Required):
? Bachelor?s Degree in healthcare administration/management with substantial quantitative coursework (e.g. statistics, economics, and finance). Master?s degree preferred.
? 8 or more years of combined health plan and/or health system provider contracting experience with a strong focus on hospital, physician, and ancillary contracting. Progressive experience in provider relations into contracting roles is acceptable.
? Expert knowledge of health plan agreement language and negotiation strategies. Proven ability to take ownership of redlines and response with review from our legal department.
? Ability to work collaboratively with partners on health plan network strategy and network design.
? Candidate will need to have experience with rate and language contracting requests and how to negotiate said requests.
Finishing Touches (Preferred):
? Experience negotiating Value Based Agreements with upside and downside risk.
? Experience with multiple product lines including Medicare, Medicaid and Commercial.
? Expert knowledge of provider reimbursement and managed care finance. In depth understanding of health claims billing data, i.e. bill type, revenue codes, POA indicators, etc.
? Reimbursement modeling experience preferred.
? Proven ability to work with a TPA or other claims processing systems.
? Proven ability to drive change in a provider organization.
? Experience negotiating and setting up Value Based Payment agreements.
? Experience in a leadership position.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin .

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