McLaren Health Plan, a division of McLaren Health Care Corporation, is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives.  We are looking for a Vice President, Provider Services MI, to join in leading the organization forward.

McLaren Health Plan (MHP) is a Managed Care Organization dedicated to meeting the health care needs of each member.  MHP and its subsidiaries offer multiple product lines, including employer plans, individual and family plans, Medicaid and Medicare plans, to Michigan residents for every stage of life.  The plan has earned the prestigious Pinnacle Award every year since 2013 from the Michigan Association of Health Plans and is also accredited by the National Committee for Quality Assurance (NCQA).

With a commitment to diversity and inclusion, a strong focus on improving the health of our members and a vision to provide the highest standards of quality and service, MHP is poised to meet the challenges of tomorrow.

Primary Location: This position is fully onsite in office, Flint MI.

SUMMARY:

Assumes responsibility and authority for establishing, directing, evaluating and coordinating all of the Plan and its subsidiaries’ Provider Relations activities.  This includes all aspects of negotiating and implementing contractual arrangements with health care providers. Provides guidance and vision for maintaining a high performing provider network and achieving established goals for member and provider satisfaction.  Directs activities related to developing and administering policy, short and long-range goals, strategic planning initiatives, internal and external reporting and regulatory communication.  Represents and acts on behalf of the Plan President and the MIG VP Customer & Provider Services in proposing actions, approving, advising, acting upon and coordinating efforts regarding all Provider Relations matters of the Plan. 

Responsible for leadership of the organization’s business services including information technology (IT) infrastructure including planning, project management, operations and systems development.

Communicates routinely with the President and MIG concerning policy recommendations and suggested course of action pertinent to the operation of assigned departments.  Establishes performance and productivity measures, quality improvement goals and cost controls to maximize resources available. Provides and communicates pertinent information throughout the Plan, MIG, and to the respective governing bodies.

Essential Functions and Responsibilities:

1. Establish, direct and monitor policy, procedures, methods, organizational goals and operations consistent with Federal and State laws and regulations, policies and rules, as well as national accrediting organization standards.
2. Develop and direct the Plan’s Provider Relations Department’s activities, to include all aspects of establishing and maintaining a qualified, robust provider network, including negotiating contractual arrangements, developing provider education programs, and servicing provider offices to meet the Plan and MIG’s strategic goals.
3. Ensure the Plan meets or exceeds all of state and federal compliance requirements. Direct, implement and provide short-term and long-term regulatory reporting to regulatory entities, internal & external constituencies.
4. Exercise strategic control over planning short and long fiscal viability in their respective areas of responsibility.
5. Responsible for development and presentation of opportunities to improve business and provider service performance, cost/productivity improvement, cost control, and profitability.
6. Continually assess and evaluate progress toward established internal, regulatory, industry and corporate benchmarks.

Required:

• Bachelor’s degree in business, health care or related field
• Five years’ experience in a senior leadership role with an HMO or managed care organization with demonstrated managerial experience in establishing and overseeing provider relations programs.

Preferred: 

• Master’s degree in business administration or health-related field
• Ten years’ experience in a senior HMO leadership position
• Leadership experience in overseeing, provider services and call center and information services for the business
• Experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions
• Direct interaction with health care providers and regulators

About McLaren Health Plan

McLaren Health Care is one of Michigan's fastest growing health systems. With 15 hospitals, annual revenues of over $6 billion, and a service area that covers 75% of the state of Michigan, McLaren is committed to the highest levels of patient care. McLaren Physician Partners is a joint venture partnership between the McLaren Healthcare System and our Physician members Our focus is on providing resources to physician offices which provide value and assist with engagement, clinical integration, contracting and quality.

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