Network and Contracting Manager

Job Locations US-FL
Job Post Information* : Posted Date 3 weeks ago(6/8/2022 11:53 AM)
ID
2022-1785
# of Openings
1
Career Area
Management

Overview

Network and Contracting Manager

 

This is a fulltime opportunity.

 

Job Location:  Florida

Novocardia is on a mission to transform the delivery of cardiovascular care for all by building the national cardiovascular network of choice for high-quality, high-value care.  We are working to empower clinicians across the United States to consistently deliver higher-quality, prevention-focused, patient-centered care, enable clinicians to be rewarded for focusing on these services for their patients, and deliver care now that avoids more advanced disease down the line.

We are seeking a talented and experienced individual to join our growing team as a Network and Contracting Manager. This role affords a singular opportunity to work closely with a world-class team to help build a disruptive, mission-driven, physician-led clinical delivery organization from the ground up! 

 

Chronic disease is the dominant cause of avoidable healthcare spending and death in the United States and worldwide.  Fortunately, much of this disease burden and associated spending is potentially avoidable through delivery of more proactive, prevention-focused care.

 

Our founding team has decades of experience in clinical medicine, payer and provider leadership, government, data science, and clinical operations.  We are deeply passionate about improving care quality, and providing more Americans with access to great, evidence-based chronic disease care. We are also deeply committed to building more sustainable and durable payment models for this care – models that reward clinicians for delivering the right care, in the right place, at the right time.  

 

We are looking for high integrity, mission-oriented people who are passionate about improving the quality and value of chronic disease care in America, excited to join a dynamic, rapidly-growing, and diverse team, and want to build a disruptive, world-class business.  We are humble, ambitious, learning-oriented, focused on execution, and all in on this venture and vision.  Come join us!

 

Overview

 

The Network and Contracting Manager will play a critical role in managing relationships and contracting negotiations with payers and risk group partners. Reporting to the Vice President (VP), Contracting and Value-Based Partnerships, this role will analyze existing fee-for-service (FFS) contracts, participate in FFS contract negotiations with payers, and own the day-to-day relationship and performance management of Novocardia’s value-based network and existing risk-based contracts.

  

Responsibilities

  • Contracting – FFS focus
    • Work with the VP, Contracting and Value-Based Partnerships to execute on FFS rate negotiations.
    • Analyze and compare various fee schedules from different sources (Medicare and Commercial payers) to identify opportunities for rate improvement.
    • Monitor and manage financial and other key performance metrics by contract.
    • Coordinate all pre-contract activities with providers, including site visits, credentialing, orientation to contractual requirements, etc…
    • Support the VP, Contracting and Value-Based Partnerships to negotiate and execute value-based care contracts and partnerships.
    • Maintain contracts and correspondence files in organized and accessible manner for all risk groups, practices and providers in CRM system.
  • Network Management – Value-based care focus
    • Serve as the day-to-day relationship manager for the Novocardia value-based care provider network (owned and affiliated cardiology groups that manage patients under risk-based contracts).
    • Analyze utilization and quality data to assess and help determine VBC performance targets.
    • Meet monthly with practices on value-based contract performance and provide recommendations and guidance tied to best practices for success under value-based care.
    • Work closely with the company's value-based analytics and finance teams to produce performance reporting and drive the right messaging to the network.
    • Prepare reports, presentations and other documents tied to VBC performance and present these materials to risk groups and network cardiologists.
  • Identify areas of opportunity from both contracting and network performance perspectives and develop action plans to enable success.
  • Communicate effectively with providers, medical office staff, insurance carriers, and internal departments to establish relationships.

Qualifications

 

  • 7+ years of contracting/negotiations experience involving payers and complex delivery systems.
  • Strong understanding of health care pricing and reimbursement methodologies (preferably complex reimbursement models, including incentive-based models), network development processes, and contract language.
  • 2+ years of experience developing and managing payer and risk-bearing provider relationships.
  • 3+ years of experience identifying, developing, and cultivating strong relationships with payer partners.
  • 1+ years of experience developing and leading execution of value-based business models associated with different types of provider organizations (single specialty, multi-specialty, hospital, CIN, IPA etc.) preferred.
  • Demonstrated ability to communicate effectively, work directly with partner practices, physicians, staff, department leads, and health plans, and develop strong working relationships within a fast-paced, matrixed organization
  • Superior problem solving, decision-making, and negotiating skills
  • Proficient in Microsoft Office, including Excel and PowerPoint
  • Resourceful and assertive; possesses the ability to leverage resources across the organization to build trust and complete tasks
  • Adept at working independently or as part of a team and demonstrates initiative
  • Committed to being a team player; excited to roll up sleeves, dig in, and collaborate with colleagues to help the Company grow and succeed
  • Acts with honor, integrity, and a high level of professionalism
  • Excited to join a dynamic, high-integrity, mission-oriented, early-stage start-up Company focused on improving care quality and building value-based reimbursement models

 

 

 

Novocardia provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to religion, race, creed, color, sex, sexual orientation, alienage or citizenship status, national origin, age, marital status, pregnancy, disability, veteran, or military status, predisposing genetic characteristics or any other characteristic protected by applicable federal, state, or local law.

 

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