American Health Care Association

Compensation

Full Description

AHCA/NCAL is seeking an Executive Director to improve lives by delivering solutions for quality care by creating and leading the development, operation and strategic direction of AHCA's provider network division and services. Qualifications & Skills: Advanced degree plus 10-15 years related health policy experience including network development and clinical integration. Duties & Responsibilities: Network Operations: Management, Clinical, Contracting and Credentialing • Create and lead the network management of state networks. • Create and lead the credentialing functions of the network, including developing and advancing claims escalation as a service and potential revenue generator. • Create and lead network contracting functions, ensuring the creation of network contracts, value-based and other alternative payment models that support network value and growth for each state. • Establish policies, practices and processes, and develop the infrastructure to support current networks and network growth. • Lead achievement of network ROI functions and communication of ROI back to network members. • Develop, cultivate and manage key network member organization, payer, or other C-suite level relationships and customer support. • Design and lead a messenger model or clinically integrated network, along with other strategic initiatives such as claims escalation, credentialling and other standalone back-office support services for members that complies with antitrust and other laws, regulation and policies. Network Department Operations • Ensure a plan for staffing operations that breaks even and supports network growth where it is appropriate and beneficial for states and members. • Create and adhere to the Integrated Network department budget. • Create network goals for the team and individuals that support and advance AHCA/NCAL and network goals. • Ensure all network functions both within AHCA/NCAL, and within each established network LLC comply with state and federal laws. Establish and adhere to a legal process for ensuring continued compliance. Advise AHCA/NCAL board on legal issues and risk. Network Development & Growth • Develop and adapt network development process and strategic plan. • Develop new networks in states that meet network viability criteria. • Establish network development process or alternative path for states that have less opportunity to form a clinically integrated network. Other duties as assigned.