Verda Healthcare, Inc. has a contract with the Center of Medicaid and Medicare Services (CMS) and Texas Department of Insurance (TDI) for a Medicare Advantage Prescription Drug (MAPD) plan for 2024. We are looking for a Regional Vice President – Houston, Texas to join our growing company with many internal opportunities.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc. is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Align your career goals with Verda Healthcare, Inc. and we will support you all the way.
Position Overview
The position is responsible for leading and achieving strategic expansion, development, implementation, and Key Performance Indicators (KPI) of a provider and hospital network for Medicare Advantage Part D (MAPD) and Chronic Special Needs Program (C-SNP) in the marketplace.
Primary Responsibilities:
- Responsible for the continued development and enhancement of the Provider Network Management.
- Work closely with the health plan leadership to ensure compliance with all regulatory and industry standards.
- Support and execute new health plan implementations, acquisitions, and expansions in collaboration with the Business Development Team.
- Drive positive cultural changes with focus on coaching and development.
- Plans, organizes, staffs, and coordinates activities of the Provider Network Management.
- Works with staff and Senior Management to develop and implement provider contracting strategies and provider service strategies to contain unit cost, improve member access and enhance Provider satisfaction enterprise wide.
- Develop a Standardized Provider Engagement “Tool Kit”, training program and deployment plan. Develop and implement approaches to determining outcomes of tools and training programs.
- Develop and oversee deployment strategy and monitoring for “Provider Profiles” and “Value-based” contracting.
- In conjunction with Provider Contracting and Operational leaders in the Health Plans identify, develop, and implement approaches for performance management of Value Based Reimbursement.
- Monitor key metrics to determine Provider Engagement effectiveness and success (e.g., Provider Appeals and Grievances, Member Appeals and Grievances, CAHPs, STAR Ratings, HEDIS, HEP Completion Rates, etc.).
Required Education:
- Master’s or bachelor’s degree in a related field (Business Administration, etc.,) or equivalent experience
Required Experience:
- Minimum 10+ years of management and strong leadership experience. Minimum 5 years of healthcare, managed care, provider services and call center operations experience in government sponsored programs.
Professional Competencies
- Excellent interpersonal and communication skills (verbal and written). Excellent leadership and managerial skills. Proven record of accomplishments in work history.