Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Hospital Service Leader

📁
Director and Equivalent
💼
EmblemHealth
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Responsible for developing and executing network and contracting strategy with senior leadership. Identify and negotiate financially beneficial terms to support business and clinical initiatives to continually advance network relationships and manage the medical trend. Ensure the that competitive contractual engagements translate into competitive rates for customers, leading to increased membership growth. Direct programs to resolve root cause claims and operational issues, and in so doing, educate providers on Emblemhealth policies, procedures and processes.  

Responsibilities:

  • Develop and lead quality relationships with providers.
  • Accountable for significant hospital and physician network contract negotiations, including leadership and oversight of the negotiation process, ensuring contracts are negotiated and maintained at the optimum cost and benefit to the organization.
  • Lead ongoing contract maintenance and resolution of business issues associated with contract terms, including financial settlements, provider reporting, etc.
  • Lead contracting team to ensure complete understanding of current contractual terms and communicate issues that may arise as the contract term is renewed. 
  • Partner with operational areas such as UM, Claims and GAD to ensure compliance with facility agreements.
  • Develop and coordinate overall contracting and contract-specific strategies and recommendations; translate provider strategies into tactical and accountable plans.
  • Lead quarterly meetings with strategic provider partners to review performance and recommend initiatives to strengthen our partnerships.
  • In collaboration with key internal collaborators, establish a measurable plan to lead the development and implementation of advanced and emerging provider network contract models and reimbursement methodologies with providers in the EmblemHealth network.
  • Maintain contracting calendars and/or a contract dashboard to ensure adherence to key contract dates/timelines related to contract requirements, adjustment and/or renewals.
  • Develop processes and practices to ensure that contracts and supporting documentation are compliant with legal and regulatory requirements, completed within leadership determined timelines and that contract terms are accurately articulated for implementation purposes.
  • Obtain documentation for credentialing and collects data pertaining NY State Health Provider Network (HPN) reporting.
  • Lead, coach, manage, and provide training to staff to ensure corporate and department goals and objectives are met.
  • Special projects as assigned.

Qualifications:

  • BS required in Business Administration, Health Care Administration, Finance or related degree
  • Masters preferred 
  • Minimum of 5 – 8 years related experience including: managed care, health administration or health education and contracting, provider and/or vendor management (R)
  • Staff management experience required (R)

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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