Vice President, Provider Networks

ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

Position Summary

The Vice President, Provider Networks is responsible for the day-to-day operations and general functions of the operational teams and sub-units, including Provider Contracting, Provider Services, and Provider Data Analysis. In addition, The Vice President, Provider Networks will plan and execute changes to that working environment. This role contributes to the development and implementation of departmental strategies, policies and procedures. The Vice President, Provider Networks assists in the identification of methods for improving department and organizational efficiency and focuses on automation of processes for improved services and workflow.

Essential Functions

1. Conducts interviews and hiring of direct reports. Completes a ninety-day introductory and annual performance evaluation of each direct report. Facilitates professional growth and improved proficiency of staff who are direct and indirect reports through mentoring and training. Conducts ongoing performance management of each direct report; establishes performance goals; and measures performance against goals.
2. Leads in developing operational strategies and tactical planning to ensure strategies are met and develops implementation plans. Works alongside FCC/ILS leadership and business area/functions in the planning and execution of strategic initiatives as appropriate. Helps set the vision and goals for the future of the health plan ensuring alignment toward those strategic goals.
3. Directs implementation of plans, policies and procedures to ensure smooth progress in the day-to-day running of health plan. Works with COO, to help organize and oversee daily operations of FCC/ILS business areas, providing constructive feedback as needed. Acts as liaison between COO and various FCC/ILS business areas to assist in every area of operations.
4. Directs all areas of FCC’s Subcontractor Delegation Oversight function to ensure smooth day-to-day operations. Oversees routine completion of subcontractor scorecards/dashboard to ensure that subcontractors are meeting required compliance metrics with AHCA and with FCC. Oversees relationship with assigned contractors with FCC/ILS to provide assistance in management of the health plan business. Works with relevant functional units to assess and onboard vendors as appropriate. Coordinates third-party administrator activities performed under FCC-ILS MSA as assigned.
5. Coordinates the administration of FCC/ILS provider-related business areas/functions, including network development and management, provider contracting, provider data management, provider relations, provider services, provider payments and complaints/disputes. Develops, implements and monitors mechanisms, including provider network verification, to ensure that FCC meets provider network adequacy, identifying gaps and carrying out strategic and technical plans to ensure improved adequacy and performance of network providers. Directs communications with network providers. Drives development of innovative provider contract arrangements designed to further FCC’s strategic objectives. Provides direction and oversight in serving network providers, including issue identification, resolution and training as appropriate. In conjunction with plan leadership, provides direction and oversight in provider relations designed to further FCC’s strategic objectives.
6. Identifies and targets areas in which a business area/function can improve operational productivity and/or profitability. Evaluates regularly the efficiency of plans, policies and procedures according to organizational goals and objectives to assess future needs and opportunities. Conducts periodic assessments of operating processes, evaluating overall performance of operational areas by gathering, analyzing and interpreting data and metrics. Identifies challenges faced by the organization to improve and standardize all aspects of operations and initiates improvements accordingly. Works with COO to create and maintain operations project reporting for FCC/ILS leadership, including board level review.
7. Monitors SMMC contract requirements and contract deadlines specific to areas of responsibility. Develops required contractual submissions, responds to AHCA requests, and operational status issues as assigned. Conducts quality review of assigned AHCA regulatory reporting related to areas of responsibility. Coordinates with FCC/ILS compliance on reporting/submission processes to ensure compliance with contract requirements and initiative for needed improvement.
8. Ensures that operational processes stay within agreed-upon budgets and timelines managing procurement processes and coordinating material and resources allocation. Reviews financial information and adjusts operational budgets to promote profitability.
9. Attends and participates in professional workshops and seminars to keep abreast of current changes in healthcare and state healthcare regulations.
10. Performs other duties as assigned.

Education and Experience

1. Bachelor’s degree in business, health-related field or have the equivalent combined education and experience as outlined below; a master’s degree is preferred.
2. 5-10 years of healthcare management experience.

Required Skills

1. Must have management and supervisory skills, communication, organization and staffing skills as well as a strong financial and budgeting acumen.
2. Strong verbal and written communication skills are important in this position to work well with a variety of employees and sometimes with clients and outside vendors.
3. Knowledge of industry’s legal rules and guidelines.
4. In-depth knowledge of diverse business functions and principles.
5. Working knowledge of data analysis and performance/operation metrics.
6. Familiarity with MS Office and various business software.
7. Effective and efficient time management skills.
8. Proven ability to plan, organize, schedule, direct, control, and monitor large-scale, multi-functional project activities.
9. Analytical skills to evaluate data and make operational decisions.

EEO STATEMENT

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.