Top Provider Network Executive jobs in Indiana

Provider Partners Health Plan of Indiana, Inc, (PPHP-IN) is a health plan that is a 100% owned subsidiary of Hoosier Senior Care Alliance, LLC (HSCA) and Provider Partners Health Plan (PPHP). HSCA and PPHP also own a 100% owned Care Management Organization (CMO), that will provide, through employment or contract, clinical services to the residents of the health plan in HSCA’s facilities.

HSCA is a collaborative owned by six quality long-term care (LTC) companies with exclusive or extensive experience in Indiana: American Senior Communities (ASC); Brickyard Healthcare; CarDon & Associates; Millers Health Systems; Tender Loving Care Management (TLC Management), and Trilogy Health Services. Through collaboration, HSCA and PPHP will raise the bar for caring and quality of Hoosier Seniors.

PPHP operates Medicare Advantage HMO plans for individuals enrolled in Medicare who reside in long-term care facilities in six states. PPHP is an innovative Special Needs Plan led and managed by a team of highly experienced long-term care providers that work with physicians, hospitals and other providers to improve the quality of care for its members. The Hoosier Senior Care Advantage Plan beneficiaries and their families benefit from PPHP’s proprietary model of care and EMR data mining technology which emphasize intense, personalized primary care, early identification and treatment of subtle changes in conditions, prevention of unnecessary acute utilization. In addition, PPHP’s integrated care delivery model ensures that beneficiaries receive the highest quality of care as the CMO’s clinicians work to collaborate with all providers across the care continuum.

PPHP will offer a REACH High Needs ACO (ACO) model to complement or supplement to the health plan.

Provider Partners Health Plan of Indiana is seeking a dynamic and results driven leader who is passionate about partnering with providers to provide excellent, compassionate, and personalized health care for seniors and can generate demonstrable results based on that mission.

Job Summary:

The Executive Director is the market leader spanning the full scope of Health Plan and CMO operations in Indiana. In addition, the role will lead development and expansion of Provider Partner’s ACO in Indiana and develop additional value-based care relationships for the CMO beyond execution of the Special Needs Plan Model of Care. Specific responsibilities include the following leadership, strategic and operational duties with particular emphasis on results and performance: Provider Network development and Provider Relations; LTC Partner performance in marketing and lead generation; Marketing and Sales implementation and results; LTC Partner results in implementation and execution of the clinical model; CMO implementation and results; and clinical program implementation and results.

PPHP-IN has entered into a management services agreement (MSA) with Provider Partners Management Services, LLC (PPMS) to provide the administrative, managerial and business services necessary and appropriate for the day-to-day management and administration of the non-medical aspects of its health plan. The CMO has entered into a MSA with PPMS to provide administrative services necessary for the day-to-day management of clinical aspects under the direction of the health plan.

PPMS is a 100% owned subsidiary of PPHP. The Executive Director will be an employee of PPMS appointed to, approved by, and under the direction of the PPHP-IN Board and CMO Board, respectively.

Primary Duties and Responsibilities:

1. Leadership

• Identify and execute strategies for team growth, including recruiting, cultivating and retaining top industry talent.
• Deliver and report on corporate wide strategic development plans, ensuring full team engagement in company mission of improving and delivering unparalleled patient care to Medicare’s most vulnerable population set.
• Engage in and coordinate with Provider Partner’s compliance leadership to facilitate adherence to CMS requirements and manage antitrust compliance activities.
• Drive organizational leadership to align with the company strategies.

2. Provider Network development and Provider Relations

• Develop, contract and maintain a strong Provider Network to ensure provider network adequacy, access, affordability and quality of care.

3. LTC Partner performance in marketing and lead generation

• Implement strategies to drive LTC partner performance to successfully market and publicize facility affiliation with PPHP resulting in achievement of lead generation goals.
• Lead and manage the Partner Development team to grow membership and meet membership goals through CMS compliant beneficiary enrollment.

4. Clinical program implementation and results

• Drive provider engagement and coordination efforts to result in high performing networks which ensure care continuity across provider spectrum, reduction of unnecessary acute utilization and achievement of MLR Total Cost of Care goals.
• Lead and manage the clinical team to meet all Model of Care requirements, provide excellent personalized care to members, and achieve total Cost of Care goals.
• Ensure timely review of each facility’s quality metrics and financial results versus budget.
• Identify and implement clinical enhancement strategies to improve care coordination, customer experience and beneficiary health outcomes.
• Propose and monitor timely corrective actions to be taken to improve a facility’s performance
• Monitor financial and operational performance inclusive of MLR achievement, STARs / HEDIS performance, Benefit Product development, Market growth and Client Service Experience.

Required Qualifications:

• 10 years experience in healthcare or health insurance;
• 5 years in healthcare or health insurance in Indiana highly preferred;
• Degree in health administration, business administration, or another related field; MBA / JD or similar masters degree is desirable.
• Excellent communication skills with executive level staff and external audiences—i.e., as the face of the health plan in Indiana, build relationships with IDOI, Governor’s Office, State legislatures and key provider stakeholders;
• Detailed knowledge of healthcare industry’s economic and operational structure, with a specific focus on experience in long term/geriatric care provider management.
• Proven track record of developing operational initiatives and go to market strategies while also leading / mentoring a high-performance management team.
• Strong business acumen as it relates to managing and motivating, negotiation skills, logistical insights, contracting and vendor procurement
• Proven track record of exceeding goals and a bottom-line orientation in a healthcare setting; evidence of the ability to consistently make good operational and strategic decisions through a combination of analysis, wisdom, experience, and judgment; high level of business acumen, including the ability to balance the delivery of health care programs against the realities of a budget; allocates resources and manages operating expenses to maximize P&L while managing risk.
• Adept in critical thinking and creative problem solving, with detailed analytical capabilities when interfacing with provider partners and other model of care stakeholders.
• Demonstrated success in business management on day-to-day basis as well as in executing decision making to drive big-picture strategic placement
• Detailed experience in managing short and long-term goals and objectives, clinical cost allocations, risk management, department budgets, human resource review, and general operational oversight.
• A team player with experience in highly complex business environments, possesses the ability to build positive mental framework with employee groups especially when faced with decisions that will influence divergent interests amongst interdepartmental functions
• Excellent messaging skillset especially as it relates to communicating value propositions, technical skills and market trends a variety of industry and partner organizations