Director of Alternative Payment Model and Vendor ContractingCommunity First Health Plans
POSITION SUMMARY /RESPONSIBILITIES
The Director will have the required knowledge of the Alternative Payment Model (APM) provider contract process and development methodology and delegated vendor contracts (i.e., vision, dental, transportation, etc.). Works across all levels of the organization to define goals, requirements, and priorities for assigned responsibilities. Responsible for the management of all Network Provider APM arrangements across all provider types to ensure defined metrics are monitored, analyzed, and shared with the appropriate provider groups and internal stakeholders. Interfaces with various departments to resolve delegated vendor contracting issues related to service delivery issues, authorization issues, access/appointment availability issues, and specific projects and initiatives in accordance with the health plan’s policies and procedures. Facilitates and monitors provider participation in provider incentive programs, and service delivery improvement activities and conducts audits to ensure compliance with regulatory and benefit program requirements.
A Bachelor's Degree in Business Administration or related field is required. A minimum of five years of experience in managed health care delivery, managed care operations, Provider APM contracting and/or delegated vendor contracting within an MCO environment or relatable experience is required. Demonstrated expertise with regulatory, compliance, and accreditation deliverables as well as problem resolution skills, presentation and communication skills, data management, and claims. Extensive knowledge of quality metrics, programs, and rating systems. Experience with assisting providers with contracting, credentialing, and claims issues is preferred. Must have a proven track record in the implementation of organization-level tools and processes.
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