It’s Time For A Change…Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—70.3% in year-over-year revenue growth in 2017. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
What you'll be Doing:
This position reports directly to the SVP, Provider Network Contracting with a dotted line to the COO, Miami Childrens Health Plan. The role will have a strong emphasis on network contracting, network adequacy builds, provider onboarding, education and training. Regarding the latter, the role will develop strong interpersonal relationships with contracted physicians and hospitals in support of provider driven health plan; at both the outset and expansion of the relationship. The Director will also work closely with Health Plan Medical Directors to develop physician education programs and to support the development of financial incentives related to improvements in coding.
The candidate should have the ability to continuously interact effectively with other Health Plan and Evolent departments; sometimes in a matrix reporting responsibility. The role will also initiate and maintain effective working relationship with TPA provider services, medical management and sales and marketing departments.
Additionally, the Director, Provider Relations and Contracting will have the opportunity to shape team culture and operating norms as a result of the fast-paced nature of a new, high-growth entity.
All other duties assigned by manager and supervisor.
The Experience You'll Need (Required):
- Bachelor’s Degree in healthcare administration/management with substantial quantitative coursework (e.g. statistics, economics, and finance). Master’s degree preferred.
- 10 or more years of combined health plan and health system provider contracting experience with a strong focus on hospital, physician, and ancillary contracting.
- Candidate will need to have experience with rate and language contracting requests and how to negotiate said requests.
Finishing Touches (Preferred):
- Experience with multiple product lines including Medicare, Medicaid and Commercial.
- Expert knowledge of provider reimbursement and managed care finance. In depth understanding of health claims billing data, i.e. bill type, revenue codes, POA indicators, etc.
- Reimbursement modeling experience preferred.
- Proven ability to work with a TPA or other claims processing systems.
- Proven ability to drive change in a provider organization.
- Experience negotiating and setting up Value Based Payment agreements.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.