Job Information
CDPHP Manager, Provider Network Growth in Albany, New York
Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.
The Manager, Provider Network Growth leads efforts around management of special projects (high-cost providers, claimants, outliers). This individual will manage and strategize solutions for out of network spend, including national networks. Leads high-cost service contracts, including but not limited to transplants, cancer care, and gene therapy. Manages assigned network operations including single case agreements, government and commercial audits and reporting and the contract lifecycle management system. Works with sales, medical management and finance to develop actions to meet market growth and medical cost targets. Leads recruitment efforts and staff toward company growth goals. May manage Tier 1 ancillary provider contracts including but not limited to lab, home health and DME, as assigned.
Qualifications:
7+ years ancillary provider negotiation experience for commercial, Medicare and Medicaid lines of business including 3 years in a leadership position
Bachelor’s degree or four (4) years of equivalent experience required.
Demonstrated lead of complex and high-dollar case contracting, including transplants and cancer care
Demonstrated lead in provider network expansion and national networks
Understanding of complex negotiations, different rate methodologies and value-based reimbursement models including but not limited to capitation, bundled payments and risk-sharing arrangements
In-depth understanding of Medicare, Medicaid and New York State fee schedules and payment methodologies
Clear understanding of contracting for complex care and cost containment strategy
Understanding of legal and regulatory contract compliance and network adequacy requirements
Excellent leadership skills with demonstrated ability to guide and inspire others
Strategic and critical thinking
Ability to influence and translate concepts into practice
Public speaking
CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay.
CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits at https://www.cdphp.com/about-us/jobs/benefits.
As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.
CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.
