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.

Vice President, Provider Network Mgmt & Population Health

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Vice President
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2013Z Requisition #
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Leadership Expectations:

Strategic Thinking. Adapts to changes in the marketplace. Identifies short and long-term functional goals and strategies. Leads change efforts in redefining how to serve customers.

Organizational Development.  Implements organization structure and communicates roles/accountabilities. Identifies, develops, and engages functional talent.  Identifies workforce gaps and develops talent to fill gaps.  Holds Directors accountable for developing others and managing performance. Identifies key talent/high potentials and informs Senior Leaders. Recognizes and celebrates success.

Transparent Communication. Constantly discusses business strategy with functional leaders; ensures employees understand how what they do links to strategy. Frequently cascades information up and down the organization. Models transparency with dashboard/metrics. Clearly and effectively communicates.

Lives the Values. Makes decisions that support the values.  Demonstrates the values in daily activities. Holds Directors accountable for living the values.  Places Company and team above self.

Continuous Improvement.  Sets stretch goals that improve performance. Takes measured risks and develops contingency plans, when needed. Develops new ways of getting work done that supports innovation efforts. Proactively works to improve processes. Promotes and rewards efforts to make the work environment open to new ideas and thinking. Continuously enhances and improves own contribution.

Accountability. Hold self and Directors accountable for achieving results. Identifies and removes obstacles to getting things done. Makes decisions in timely manner. Displays ability to make difficult decisions.

 
Responsibilities:
  • Accountable for oversight, direction, management and development/implementation of the policies, procedures, strategies and tactics governing the successful economics and operations of provider relationships with hospitals, medical groups, risk bearing entities, specialty contracts and several other broad provider categories.  This includes exercising authority over provider negotiations, risk relationships, Medical Group management, HCC revenue contracts, disease management contracts, facility credentialing, provider communications, regulatory and legal compliance, contracting, rate negotiation, orientation, outreach and monitoring/problem resolution as well as serving as the “face” of EmblemHealth to the plan’s major trading partners (medical groups, hospital systems, etc.).  Will also have oversight of EmblemHealth’s new health care delivery system.

  • Develop strategies for recruiting and retaining providers necessary to effectively and efficiently service Emblem’s products, including physicians, hospitals, home care, ambulance services, ambulatory surgery, nursing home, etc.

  • Provide leadership and direction relative to the administration of all provider contracts including maintenance of provider files, discount calculations and reconciliation’s, rate and fee files for both internal and external claims processing and manage provider relationships within MER goals and profitability margins.

  • Oversee and execute around medical vendor relationships including disease management vendors, HCC coding revenue vendors, extended network vendors (rental network arrangements).

  • Direct the cost and fee analysis necessary to support provider rate negotiation. Direct the data development necessary to support negotiations, particularly with respect to hospital and risk related contracts.

  • Manage administrative expenses to approved budget levels.  Lead, manage, develop and inform a team of professionals and support staff.

 
Qualifications:
  • Bachelor’s Degree required, Master’s Degree preferred

  • 12 – 15 years of relevant experience in the healthcare industry.

  • Proven leadership in managing large, cross-functional organizations.

  • Demonstrated experience and success in managing through matrixed, complex organizations; ability to work collaboratively with various parties in defining and achieving common goals.

  • Ability to communicate, persuade, convince, influence, and negotiate with all levels within and outside of the organization.

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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📁 Vice President