Vice President, Network Management – San Diego County in San Diego at Prospect Medical Systems

Date Posted: 10/17/2020

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    California
    San Diego
  • Experience:
    Not Specified
  • Date Posted:
    10/17/2020
  • Job ID:
    16801

Job Description



Vice President, Network Management, San Diego County

San Diego, California Market Experience is Required
Position Location: San Diego, California

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Responsible for achieving regional financial metrics, benchmarks, membership targets and physician development goals, while ensuring quality and satisfying service to members, physicians and provider partners. Develops and implements strategic expansion plans, executes revenue-driven initiatives in a highly competitive marketplace and achieves membership growth goals via retention & new growth.  Works closely with IPA/MSO clinical leadership to help achieve metrcis while ensuring access and meeting regulatory requirements. Responsible for ensuring compliance with company and regulatory requirements, mandates and ACA reform.  Identifies technology and procedure improvements for increased efficiencies, accuracy and continuous process enhancements. Implements strategies across all lines of business considering product-specific factors to optimize patient care and network performance.



Job Responsibilities/Duties

  • Impacts Prospect’s profitability and market position in assigned region by managing the following:  strategic membership growth initiatives, medical loss ratio, performance program compliance (HEDIS, P4P, STARS), RAF score improvement, clinical care program participation, encounter data submissions, provider satisfaction, provider contract strategy and physician rewards / bonus programs.
  • Provides leadership, mentoring and management to Network Managers and support staff to advance team members, while developing metrics and tools to measure/effect progress on team goals:  increase revenue and reduce unnecessary expenses; grow membership strategically; build strong relationships with providers and health plans; and achieve quality performance metrics.  Ensures team’s compliance with company policies, procedures and workflows and strategic use of tools and reports.
  • Perform and supplement network development and expansion functions, including identification of viable physician practice acquisitions to meet identified Fiscal Year metrics.  Work with internal regional teams to facilitate leads and procure and engage external prospects. Coordinate initial acquisition data retrieval, coordinate with designated PMS Financial Planning & Acquisitions team for analytics via interface with potential acquisition practice to obtain necessary documents for negotiations.
  • Collaborate and market networks with brokers and health plan career agents to increase membership across targeted product lines.  Identifies and seizes new business opportunities to ensure achievement of revenue-driven objectives.
  • Thoughtfully expands contracted provider base, exclusivity arrangements and niche network opportunities. Ensures tactical region development, specialist panel progression and provider maintenance to attract and retain members. 
  • Maintains effective relationships with providers and nurtures partnerships with health plans, hospitals and local community resources.
  • Organizes and/or conducts effective Joint Operation Committee meetings and/or management review sessions with designated providers and/or groups to further company goals. 


Qualifications

Minimum Education: Bachelor’s degree required, advanced degree preferred

Minimum Experience: 7+ years of experience in the healthcare industry, preferably with direct physician interaction. 5+ years of experience with management and metric management in a process and/or service environment. Strong computer skills, Word, Excel, Access, Power Point, and office equipment. IDX experience highly desirable. Proven success in achieving & surpassing key performance metrics, including membership growth, physician performance and financial targets. Working knowledge of federal and state legislation related to HMO & IPA entities, including Department of Managed Health Care, Centers for Medicare/Medicaid, and Department of Health Services. Strong written, verbal, and presentation skills. Ability to effectively present information and respond to questions from senior management, employees, physicians and patients. Ability to shift from a high-level strategic focus regarding initiatives to a detail-oriented task-driven focus as well as working concurrently on a variety of tasks/projects with competing deadlines and turnaround times. Ability to motivate and engage staff, building trust and consensus, and appropriately delegating and empowering a high-caliber professional team. Must have advanced reasoning and highest level of problem solving and planning skills

Req. Certification/Licensure: None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit   https://prospectmedicalsystems.com/about-us/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: HEDIS, P4P, STARS, RAF, Compliance, Managed Care, Healthcare Plans, Project Management, VP, reporting, provider communications, Leadership, community resources, operations, Analytics



16801

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