Details: Job: Directors & Managers At the direction of the VP of Strategic Pricing & Analytics: (1) Participate in developing Provider Networks, IPA, ACO, and/or PHO organizations; and (2) Administer, coordinate and support all Network, ACO, IPA and/or PHO maintenance and reporting activities on behalf of the Divisions/Markets comprising the Region, pursuant to the business/financial plans and SP&A policies and procedures. The primary responsibility is to manage the overall operations of the entities, coordinating all reporting and internal communication to the IPA/PHO members as well as coordinating all IPA/PHO issues with the Strategic Pricing & Analytics team and the Division leadershipDevelop and present for approval annual budgets and business plans for the entities.Direct any current and future staff of the entities.Oversee all credentialing activities of the entities.Organize and Conduct all IPA/PHO Board and Committee meetingsSupport network committees and board of directors by preparing meeting materials, ensuring efficient communication of network activities, and prioritizing key information necessary for the effective operation of the committees and boards.Serve as implementation coordinator with outside MSO service vendors to ensure proper and timely MSO functions and coordinate activities between IPA/PHO, the payer and the MSO vendor, including Credentialing, Claims Payment, Utilization Management; Network Management and other delegated functions.Ensure assimilation as a key member of Group/Division/Market operations management team (e.g., Presidents, CEOs, CFOs, COOs, CNOs and Directors, including hospitals, ASCs, IDTFs and HCA Physician Services), and provide expertise, support, constituent advocacy, education, involvement in legislative issues, budgeting tools and other communication strategies to ensure a commonality of understanding, purpose and direction in all market-based SP&A activities.Serve as the primary contact with all payers for current and future contract development.Ensure that a permanent record of all negotiations and documentation relating to IPA/PHO contracting activities is maintained, and provide copies of finalized documents to the Shared Service Center, ASD, HCAPS and other operational counterparts as may be applicable to the contract in question, on a need-to-know basis.Interface with medical staff and develop & present PCP/office staff training in tandem with payerSchedule and attend regular training meetings between practice managers & payerServe as lead in implementation of IPA/PHO agreements in the Division/MarketEnsure provider compliance with government regulations and Payer requirements.Maintain current knowledge of State and Federal regulations, laws and legislative agendas regarding the healthcare industry, paying particular attention to those that involve healthcare reform, managed care and health insurance.Practice and adhere to HCA's mission and values statement and code of conduct, and attend all required ethics and compliance training and retraining.Perform other duties as may be assigned or requested by the VP, Division CEO/CFO, HCAPS and hospital leadership.
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