VP - Network Provider Management
Reporting directly to the COO
Manage the portfolio at a national level
About Our Client
Client is a leading stand alone health insurance player
- Manage and develop team(s) to deliver improved healthcare services to our customers, case managing the interface with providers of care and customers for the best possible long term outcome.
- Establish and manage simple and streamlined pre-authorisation & re-imbursement processes and criteria that enhances the customer experience and improves provider relations.
- Proactively improve work practices and processes in order to maximise the team and departments performance.
- Deal with escalated customer queries, stemming from underwriting, pre-authorisation and case management issues.
- Set performance metrics and agree service level standards between claims and sales & service teams.
- Thorough analysis of historic data and forecasting, plan future resource requirements.
- Develop and execute strategies that support the goal of sustainable affordability by minimizing claims risk, including:
- Developing and implementing effective risk and case management strategies
- Negotiation with hospital and provider contracts for quality cost efficient services
- Driving and influencing necessary industry and health service delivery reform
- Develop and provide leadership in relation to wellness models and programs. This could include:
- Contribution to disease management and preventative health initiatives that improve quality of life, specific health outcomes and add value to health insurance of claiming and non claiming members
- Promotion of evidence based clinical practice to providers and members so as to positively influence utilisation, quality and safety of treatments and including the promotion of non-admitted health services where they can deliver more efficient and effective outcomes for specific health conditions.
- Use analytics to drive strategy and informed decisions in areas of
- Provider contracting to achieve the right geographical spread, right grade mix
- Negotiate tariff
- Monitor performance (medical, financial, customer)
- Develop provider payment strategies and models
- Define payment processing cycles to achieve best financial outcome for company without compromising customer experience
The Successful Applicant
Basic Experience & Skills:
- Demonstrated experience in the health industry
- Extensive medical, insurance industry experience.
- Good organizational, planning and delivery skills.
- Ability to make considered business decisions based on explicit and implicit data and information.
- Diplomatic, self-confident and authoritative.
- Used to working in a high pressure environment and meeting challenging service standards.
- Project management experience including of claims management IT systems or experience in working with evolved claims management systems
- Good presentation, communication skills
- Problem solving ability with the ability to consider out of the ordinary situations and know when it takes good business sense to override standard guidelines.
- Consideration must be given to clinical, often complex medical and policy issues in order to make decisions.
- Ability to proactively identify potential impacts of interventions, strategies
- Identification, facilitation of and consultation with stakeholders as appropriate.
- Ability to provide honest, accurate and timely feedback regarding performance, giving guidance and encouragement to develop potential.
What's on Offer
- Leadership role
- P&L responsibility