Vice President, Network Management

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts.

The Job

The Vice President (VP), Network Management maintains responsibility for the overall contracting of a provider network for the organization. The VP, Network Management will be responsible for the overall financial and regulatory performance of SCAN’s provider network. Oversight of negotiating and executing contracts and manage business relationships with SCAN contracted physician organizations, hospitals and ancillary providers within the CA market to support organizational goals including membership growth, retention, margin, and quality.

You Will

1. Responsible for overseeing the provider network performance related to financial, operational, regulatory, quality and growth targets. Works closely with the CA medical director on quality and clinically related issues and interacts with c-suite and management level provider staff on overall performance issues.
2. Develops provider specific performance improvement plans based on identified needs that support accurate coding, quality/stars, financial and compliance-based measures. Tracks progress of plans and deploys data analytics and subject matter experts to influence and support the case for change.
3. Oversee the negotiations of contracts in a fiscally responsible manner to ensure a sustainable, high quality, compliant network by working with Finance, Sales, Legal and other internal stakeholders on group, hospital, and ancillary contracts.
4. Oversight of the collaboration with Sales to develop regional growth strategies by pursuing new networks, providers, and vendors via executed contracts.
5. Establishes and maintains a productive working relationship with SCAN’s network provider leaders and their downstream staff.
6. Oversees network administrative functions including but not limited to: the provider portal system, provider operations manual, policies and procedures, RFPs, provider disputes and settlements, and network regulatory activities.
7. Establishes regular contact with physician organization operational and clinical leadership to build strong relationships to maintain a stable provider network.
8. Directs and supports staff by communicating job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures.
9. Responsible for maintaining staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
10. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
11. Ensures that the organization's policies for drafting contracts, conducting negotiations, and administering provider agreements are followed.
12. Responsible for contractual compliance with government regulations.
13. Contributes to team effort by accomplishing related results as needed.
14. Actively support the achievement of SCAN’s Vision and Goals.
15. Other duties as assigned.

Your Qualifications

1. Bachelor’s or Master’s degree in business or healthcare required.
2. 10+ years Managed Care experience.
3. 10+ years Management experience.
4. Successful track record of aligning network strategies with the organization’s goals, such as membership growth, retention, and quality improvement.
5. Strong Contract Negotiation and Financial Acumen.
6. Knowledge of CMS, DHCS and other regulatory and compliance requirements strongly preferred.
7. Strong analytic, quantitative, and problem-solving skills required.
8. Strong negotiation, interpersonal and presentation skills with an ability to appropriately and effectively address diverse audiences required.
9. Proficiency in MS Office and Outlook required.

What's in it for you?

• Base Pay Range: $250,000.00 to $300,000.00 annually
• Work Mode: Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO) along with 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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