HireDiversity

Our High Performance Network (HPN ) division is a high growth area of Coventry.  This department is responsible for the development, deployment, and ongoing operations of our High Performance Network which is a new model of care characterized by a collaborative partnership between Coventry and Health Care Providers through innovative reimbursement models.  This patient centric model enables Coventry and its health care provider partners  to improve member satisfaction, achieve continual improvements in quality of care, while appropriately rewarding providers for improved quality and efficiency of care through the principles of evidence based medicine.

ESSENTIAL RESPONSIBILITIES:

Expand the High Performance Network by identifying and recruiting providers

Negotiate HPN agreements to achieve increased quality outcomes and shared savings opportunities

Coordinate cross functional teams of care management, medical administration, provider relations, and finance to achieve quality and efficiency targets

Develop enhanced working relationships with our HPN’s in all aspects of the successful implementation of the program

Responsible for deployment and ongoing operations of Coventry’s suite of analytical tools providing the HPN with actionable information about quality and cost effectiveness

Accountable for incentive programs and provider engagement strategies to enhance member’s care experience through coordination of condition management, complex case management, closing Gaps in Care, and other clinical and pharmacy programs

Under limited supervision, responsible for research, analysis, and negotiation of HPN contract agreements

Develops and implements a formal, documented ongoing program to ensure good

communications with all HIgh Performance Network providers.

'Coordinates all aspects of contracting activities as related to Information Systems, Claims and Medical Management.

' Develops and recommends to senior management appropriate reimbursement methodologies.

Coordinates the preparation of financial impact analysis.

' Assists senior management with provider pricing forecasts and analysis of reimbursement for new technologies.

' Assists senior management and staff in planning, recruiting and implementing

 for a broad range of providers (physician, ancillary, and hospital providers)..

' Assists senior management and staff with the development and monitoring of

provider contracts.

Prepares and evaluates reports regarding the High Performance Network.

' Manages the addition and termination of providers into the HPN network. Ensures

the accuracy of provider

data entered into the provider database.

' Performs other duties as required.
Qualifications:

 JOB SPECIFICATIONS

Bachelor's degree or equivalent experience.

Significant experience (usually 6+ years) of hospital system and/or health insurance industry experience

Substantive knowledge of managed care policy, reimbursement methodologies and contracting tactics with an understanding of healthcare reform and trends in healthcare.

Knowledge of ICD-9 and CPT codes

Strong analytic and problem solving abilities. Proficient in Excel

Strong communication and negotiation skills (Microsoft Word, PowerPoint), including formal presentations for all levels of management.  Position will report to Director of High Performance Network.

 
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.

Job: Professionals
Primary Location: Harrisburg, PA, US
Organization: 23000 - HealthAmerica Pennsylvania Inc
Schedule: Full-time
Job Posting: 2012-11-27 00:00:00.0
Job ID: 1212292