Reviews contracts and facilitates contracting with the VNSNY CHOICE provider network as it pertains to Independent Practice Associations (IPAs), hospitals, facilities and other strategic provider entities. Negotiates and coordinates the implementation of IPA, hospital and other provider agreements. Supports the strategic alignment of the network to align the company’s various product offerings.
Negotiates contractual terms, services and rates of reimbursement with hospital, IPA, facility, group practices and individual physicians to foster network expansion and maintenance within established guidelines.
Reviews contracts to ensure regulatory and financial compliance.
Ensures that all contract templates are compliant with State and Federal guidelines.
Manages the implementation of key agreements on behalf of Network Development.
Reviews and analyzes utilization trends, issues and complaint reports regarding IPAs. Identifies trends and addresses them with IPAs and hospitals or develops strategic actions for resolution of larger issues.
Works with other VNSNY business units to coordinate efforts and leverage resources in provider contracting, network performance, reimbursement and other related matters.
Keeps abreast of current industry trends, governing regulations, reimbursement practices and market players. Keeps VNSNY CHOICE management informed of trends/changes and makes recommendations based on this information.
Participates in special projects and performs other related duties as assigned.
Education: High School Diploma or equivalent required
Experience: Minimum four years of experience in health care, with a minimum two years of experience in provider relations or contracting capacity preferred. Experience working with network service providers and negotiating/administering contracts required.
The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life. Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 44,000 patients and members, helping them to live the best lives possible in their homes and communities.