Submission for the position: Acting CEO (Vice President) - (Job Number: 1186780)
https://centene.taleo.net/careersection/jobdetail.ftl?job=1186780&lang=en
Acting CEO (Vice President)
Position Purpose:
• Oversees provider network management to ensure members’ access to quality care. Develops strategic goals and objectives and ensures adherence to the organization’s short- and long-term business/strategic plan.
• Leads the negotiation of contracts with Payors, the Managed Service Organization, and providers, including the evaluation and negotiation of incentive proposals.
• Staffs the Board of Managers and participates in Committees and adhoc work groups
• Ensures adherence to regulatory and contractual requirements.
• Oversees operational policies and procedures to ensure optimization and compliance with established standards and regulations.
• Represents the organization in its relationships with stakeholders, including health care providers, government agencies, trade associations, health plans, and others.
• Ensures the adequacy and soundness of the organization’s financial structure and available resources. Oversees financial viability and provides reports to the Board.
• Negotiates and otherwise arranges for an outside financing needs as required and approved by the Board
• Oversees the administration of value-based contracts across the provider network.
• Responsible for growing the provider network and conducts ongoing network and provider analysis by researching financial risk in current service areas and new areas for development.
• Enhances network provider relationships by conducting timely and effective meetings with comprehensive data-sharing, and responding to requests for information
• Monitors and influences network provider performance by resolving issues related to capitation, claims, and other operational and clinical functions.
• Maintains awareness of network changes by issuing timely and accurate communications about contractual risks, disposition changes, provider terminations and additions, and panel closures
• Maintains understanding of healthcare affiliation patterns and trends, and the political/financial forces driving network movement.
• Demonstrates knowledge of regulatory compliance issues as they relate to provider contracts. Successfully conveys the need for regulatory and contract changes to providers.
• Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental policy and procedure guidelines and time frames.
• Maintains up-to-date and accurate provider data
• Leads or participates in internal and external process improvement endeavors.
• Oversees the process and resolution of corrective action plans administered to network providers.
• Ensures development of marketing and communication plans/materials.
• Promotes enrollment growth by supporting marketing events, planning and execution
Education/Experience: Bachelor’s degree in Business, Health Care Administration, Public Administration or related field. Master’s degree preferred. 10 years of experience in top leadership position(s) and 5 years experience in the healthcare industry. Extensive experience in contracting, contract acquisition, operations management, or strategic planning and development, with IPA experience preferred. Behavioral health or human services experience preferred.
This role will be the Acting CEO of the IPA - Integrated Care Network Florida. The position will be in one of our Tampa, FL offices.  Remote/Telecommute is not available.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Health Insurance Operations
USA-Florida-Tampa
Schedule: Full-time Location(s): USA-Florida-Tampa