Vice President, Provider Network and Contracting - Myzinghealth : Job Details

Description

COMPANY OVERVIEW

Zing Health is a tech-enabled health insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs, and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

SUMMARY DESCRIPTION

The Vice President of Provider Network and Contracting will lead the development, management, and optimization of the provider network for our Medicare Advantage health plan. This role is responsible for overseeing provider contracting, network development, relationship management, and ensuring compliance with regulatory requirements. The VP will drive strategic initiatives to enhance network performance, improve provider satisfaction, and deliver high-quality, cost-effective care to members.

ESSENTIAL FUNCTIONS

• Network Development and Strategy:
• Design and implement strategies to build and maintain a robust, high-performing provider network that meets the needs of Medicare Advantage members.
• Identify and recruit providers (hospitals, physicians, ancillary services) to ensure adequate geographic coverage and access to care.
• Analyze market trends and demographics to anticipate network needs and expansion opportunities.
• Provider Contracting:
• Lead negotiations for provider contracts, including fee-for-service, value-based, and risk-sharing arrangements.
• Develop and implement reimbursement models that align with quality, cost, and performance objectives.
• Ensure contracts comply with Medicare Advantage regulations, CMS guidelines, and state-specific requirements.
• Relationship Management:
• Foster strong, collaborative relationships with providers, including hospitals, physician groups, and other healthcare organizations.
• Address provider concerns, resolve disputes, and promote engagement to enhance network performance.
• Serve as the primary point of contact for key provider partners.
• Regulatory Compliance and Performance:
• Ensure the provider network meets CMS star ratings, HEDIS measures, and other quality metrics.
• Monitor and report on network adequacy, provider performance, and compliance with federal and state regulations.
• Implement initiatives to improve provider satisfaction and member outcomes.
• Leadership and Collaboration:
• Lead a team of network management and contracting professionals, providing mentorship and fostering a high-performance culture.
• Collaborate with internal departments (e.g., clinical operations, finance, compliance) to align network strategies with organizational goals.
• Present network performance reports and strategic recommendations to senior leadership and the board.
• Financial and Operational Oversight:
• Manage the provider network budget, ensuring cost-effective operations and contract terms.
• Monitor utilization, cost trends, and provider performance to identify opportunities for improvement.
• Oversee the development and maintenance of provider directories and network-related systems.

Requirements

Qualifications

• Education: Bachelor's degree in Healthcare Administration, Business, or a related field; Master's degree (MBA, MHA, or equivalent) preferred.
• Experience:
• 10+ years of experience in healthcare provider network management, with at least 5 years in a leadership role.
• Extensive experience in provider contracting, including value-based care models and Medicare Advantage programs.
• Proven track record of building and managing provider networks in a Medicare Advantage or managed care environment.
• Skills and Competencies:
• Strong negotiation and contract management skills.
• Deep understanding of Medicare Advantage regulations, CMS requirements, and healthcare reimbursement models.
• Exceptional leadership, communication, and relationship-building abilities.
• Analytical mindset with the ability to leverage data to drive decision-making.
• Proficiency in network management software and healthcare analytics tools.
• Certifications: Relevant certifications (e.g., CPC, CHC) are a plus.

Work Environment

• Full-time position with occasional travel to meet with providers and attend industry conferences.
• Hybrid work arrangement with regular in-office presence required.

Compensation

• Competitive salary commensurate with experience.
• Comprehensive benefits package, including health, dental, vision, and retirement plans.
• Performance-based bonuses and incentives.