Director of Network Contacting

Company: Morgan Consulting Resources, Inc. - Healthcare Exe
Location: Stockton
Posted on: June 22, 2022

Job Description:

Morgan Consulting Resources is an executive search firm focusing on the Healthcare Industry for 25 years. We have been retained by P3 Health Partners - California/MedCore HP (P3 HealthPartners) to conduct a search for a Director of Network Contracting for the California market. This is an exceptional opportunity to be part of a fast-growing physician-led organization that keeps patients at the center of care. This hybrid position is located in Stockton, CA with some remote work opportunity within the Central Valley.About the Company:Founded in 2017, P3 Health Partners is a patient-centered and physician-led population health-management company. Founded and led by physicians, P3HP is a team of doctors, clinicians, and support service professionals with a shared passion and purpose for improving the way patient care is delivered. Their business strategy is to support providers, care teams, and practices in their journey from traditional volume-based models to value-based systems of care and wellness. Through strategic partnerships, they strive to make healthcare better for millions of patients and their families, thousands of clinicians and caregivers and dozens of payers.Currently operating in Nevada, Arizona, Florida, Oregon, and California, P3HP is also assessing opportunities in multiple states. They are building scalable care delivery systems that accept and manage clinical and financial risk for large patient populations.In January 2022, P3 Health Partners announced the closing of the company's acquisition of Medcore HP, a health plan licensed under the California Knox-Keene Health Care Service Plan Act of 1975, and Omni IPA Medical Group, Inc., an independent practice association in San Joaquin County, California. P3 Health Partners is a publicly traded company on the NASDAQ (PIII). Visit P3HP's website at https://p3hp.org/ for further information about the company. About the Position:Reporting to the VP of Contracting with a dotted line to the Market COO, the Director of Network Contracting will lead the market's contracting activity and produce outcomes consistent with corporate guidelines and requirements. The incumbent will be responsible for overseeing the network expansions and identifying future opportunities. They will offer technical contracting leadership and expertise. The Director of Network Contracting will also manage budgeting and forecasting initiatives for network costs and provider contracts. We are looking for candidates who are familiar with the provider community in the Central Valley to assist with expansion to Sacramento and other areas within the Central Valley down to Bakersfield, CA.The successful candidate will have experience with:

• Medicare Advantage population health management;
• Value Based Contracting;
• Fee for Service contracting;
• Capitated rate models; and,
• Medicare Advantage reporting.Membership: 12,500 Medicare Advantage Members; 2000 commercial members (currently contracted with three health plans and expecting two more large payor additions for 2023)Provider size: 117 PCPs and over 300 specialty/ancillary providersTotal staff in Stockton, CA: 60Staff reporting to this position: 2Travel: Local travel to visit provider offices Short term goals:
  • Geographic expansion into Sacramento and other counties located within the Central Valley.
  • Align PCPs around value-based outcomes (managing the performance of the network).
  • Analyze the network for appropriateness/refinement.
  • Work closely with the Provider Engagement staff to roll out new tools for the physician network to enhance quality and efficiency.
  • Roll out and maintain PQIP (PCP Provider Quality Incentive Program).Education/Experience:
    • Bachelor's degree; MBA, MHA, or MPH strongly desired.
    • Minimum of 10 years of specific work experience in managed care contracting to include network expansion projects, hospitals, specialty physician and ancillary contracting.
    • Well versed in CMS reimbursement and capitated, per visit, per diem, DRG, APC, and fee for service methodologies.
    • Exceptional provider contracting negotiation experience.Essential Functions:
      • Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.
      • Responsible for overseeing new network expansions and future opportunities.
      • Negotiates, implements, and manages capitated and fee-for-service agreements with individually contracted Primary Care Physicians (PCP), medical groups, hospitals, ancillary providers, and specialists.
      • Analyzes current and projected network needs from cost/utilization and competitor standpoints.
      • Analyzes, negotiates, and drafts contract rate and language proposals consistent with corporate guidelines for language and financial and operational performance.
      • Oversees administration of the contracts to ensure anticipated results, identify negative performance trends, and implement cost containment and other improvement strategies, including PQIP.
      • Collaborates with regional executive team and other departments to ensure contracted network support of operating goals, including STARS, HEDIS, and Medicare Risk Adjustment, and other initiatives.
      • Oversees any required contract amendments and resolves contract disputes/issues.
      • Contributes expertise to development of organizational best practices.
      • Coordinates managed care contracting for acquisitions and networks.
      • Leads cost saving contracting initiatives within assigned market and initiatives that may lead to cost savings in other P3 markets.Culture:P3HP is highly entrepreneurial and has a supportive and collaborative team culture interlaced with fun. Candidates with proven ability to function well within a fast-paced, hands-on and metrics/data driven environment will excel in the organization. The culture values always doing the right thing for the patients and having fun in the process. Innovation is highly encouraged.A complete position description can be found on our website at www.morganconsulting.com.Please contact Rosie Saenz at rosie@morganconsulting.com.

Keywords: Morgan Consulting Resources, Inc. - Healthcare Exe, Stockton , Director of Network Contacting, Executive , Stockton, California