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 Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives. McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.orgMDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/

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