SVP, National Provider Contracting & Network Strategy

Job Summary:

The Senior Vice President, Health Plan and Hospital Provider Contracting and Network Development, is directly accountable for provider contracting across Kaiser Foundation Health Plan and Hospitals (KFHP/H) in partnership with national functions and market leadership. As a key enterprise leader, this position advances an integrated, nationally aligned integrated care and coverage strategy while supporting the unique needs of local markets. The role is responsible for establishing provider contracting strategies, structures and processes in order to ensure that provider contracting meets organizational business objectives including compliance and economic risks. This leader will drive increased consistency and effectiveness of these agreements through the use of strategic contracting strategies, relationships and expertise with the ultimate goal of ensuring that these agreements are designed and implemented in a manner that drives affordable, high-quality and accessible care.

The Senior Vice President advances an enterprise approach to provider contracting by establishing common standards, enabling market execution, and fostering greater consistency and strategic alignment across the enterprise, while preserving the flexibility needed to address local market conditions, inclusive of delivery system strategy and product strategy. This leader is responsible for establishing direction, policies, procedures and standards for the Provider Contracting and Network Development Department necessary to deliver high-performance networks for national and market contracts as well as for KPIC provider networks. The Senior Vice President supports the development of management reporting capabilities as well as standardized data, tools and best practices that enable data-driven decision making, and strengthen enterprise-wide contracting and network performance management.

Essential Responsibilities:

• Oversees, aligns and coordinates enterprise provider strategy development to meet KPs organizational objectives through leveraging best practices, reducing unwarranted variation and taking advantage of KPs scale. Partners with market leadership to ensure that each region has a provider strategy that meets long and short-term market needs.
• Engages with Business Development when a provider relationship has been identified as a strategic relationship, including circumstances affecting multiple regions.
• Leads the development of multi-year roadmap to achieve common standards across key provider contracting agreements. The leader and the National Contracting Team will
• Conduct program-wide analysis to identify best practices and terms.
• Create national model for agreements with common components across all regions. Employ best in class provider compensation and incentive strategies to create highly effective agreements aligned with regional business strategies and compliance requirements.
• Champion and codify into agreements a holistic integrated program that works across the care delivery continuum to achieve desired performance.
• Support regions in developing multi-year approaches to meet common standards and increase alignment across the program.
• After common standards are achieved, continue to identify opportunities for improvement based on KP organizational initiatives, evolving regulatory requirements and other factors.
• Engage with regional leaders to align around national provider contacting initiatives to achieve desired contract performance aligned with the organizational strategic initiatives.
• Oversees the creation, in collaboration with National Finance and Integrated Care & Coverage, a routine management reporting capability to inform leadership at both a national and regional level on the performance of the network including access, service, quality and cost. Monitors and evaluates network performance, identifying opportunities for improvement and leading corrective actions in partnership with national and market leaders.
• Oversees the development of standardized data, reporting, and best practices to support regional provider contracting teams by providing
• relevant market data, including external benchmarking data, and budgeting support
• consistent and appropriate data collection and reporting processes across all regions
• standard tools and templates for contracts and electronic approval process
• Leads enterprise contracting technology strategy, including the selection, deployment, and adoption of common systems, tools, and platforms that enable consistent contracting and provider relationship management across markets
• Oversees the development and implementation of systems and tools that support effective administration of agreements across regions, including but not limited to:
• policies / guidelines regarding oversight practices to be employed
• reporting that enables effective monitoring of key controls to demonstrate adherence to key agreement details
• independent reviews as appropriate to validate data and / or other agreement deliverables.
• Establish and advance provider relations strategies and capabilities that strengthen provider partnerships, improve provider experience, support issue resolution, and enable effective implementation of enterprise contracting objectives
• Manages vendor and direct contract relationships for KPIC including PPO and pricing vendors. Maximizes performance of KPIC contracts. Aligns contracting processes and policy with KPIC Operational requirements.
• Increases knowledge base and competency in developing highly effective provider agreements through establishment of and support for a Provider Contracting Community of Practice. This includes conducting training, disseminating information about key topics / initiatives, identifying areas of common interest across Markets and directing initiatives related to provider contracting, facilitating communication and information sharing across Markets, providing a forum for alignment with functions impacting or impacted by provider contracting such as Legal, Claims and Actuarial Services.

Basic Qualifications:

Experience

• Minimum fifteen (15) years of progressive executive leadership experience in provider contracting, network development, healthcare strategy, managed care, or related healthcare environments leading enterprise transformation and governance through influence in a matrixed organization.

Education

• Bachelors degree in business, Health Administration, Public Health or related field required.

License, Certification, Registration

N/A

Additional Requirements:

• Demonstrated success managing large-scale provider spend and total cost of care initiatives through contracting, network design, and performance optimization.
• Experience negotiating and managing high-value agreements with integrated delivery systems, academic medical centers, national health systems, and large multi-specialty provider organizations. Track record leading negotiations involving significant financial, regulatory, and strategic implications.

Preferred Qualifications:

• Masters degree in business, Health Administration, Public Health or related field highly preferred.

#J-18808-Ljbffr