Morgan Consulting Resources has been retained by the highly regarded and nationally recognized Geisinger Health Plan to conduct the national search for the Director of Provider Network Development. The position is based in Danville, Pennsylvania.

About the company:

 

Geisinger Health Plan (GHP) is an integral part of what is collectively referred to as Geisinger Health System.  The System is a large, comprehensive health care network that provides health care services throughout a large portion of Pennsylvania.  The System is dedicated to community-focused, not-for-profit, physician-led health care medical research and education, and service to rural areas.  Initially GHP was a group practice HMO, meaning its provider network was composed of Geisinger Health System providers only.  GHP has since expanded into a network model to better serve the residents of central and northeastern Pennsylvania.  Sites throughout the service area provide additional convenience to members and better meet the needs of employers.

GHP plays an important role in the success and mission of Geisinger Health System.  Based in Danville, GHP provides insurance coverage to 230,000 residents in 42 counties in Pennsylvania and has a provider network with more than 3,500 primary care physicians, 23,700 specialists, 1,400 primary care sites, and 88 hospitals.  GHP offers a wide range of products including HMO, PPO, employer self-funded, high-deductible plans, and indemnity insurance at affordable rates for individuals, families, employer groups, and Medicare beneficiaries.

Geisinger Gold and Geisinger Health Plan (GHP) are the top-ranked commercial and Medicare health plans in Pennsylvania and in the top ten nationally for quality and service. U.S. News & World Report produces their annual America's Best Health Insurance Plans list in conjunction with the National Committee for Quality Assurance (NCQA).

Geisinger Health System has been acknowledged several times by President Obama, including a TIME Magazine article from July 29, 2009 where he stated “if we could actually get our health-care system across the board to hit the efficiency levels of a…Geisinger, we actually would have solved our problems.” Or his comments at Green Bay Southwest High School on June 11, 2009: We have to ask why places like the Geisinger Health system in rural Pennsylvania…can offer high-quality care at costs well below average, but other places in America can't. We need to identify the best practices across the country, learn from the success, and replicate that success elsewhere.

 

The Geisinger Health System difference:

What helps make Geisinger different than other U.S. healthcare providers is the integration of the health system’s hospitals, approximately 800-member physician group practice, system-wide research initiatives, 230,000-member health plan and extensive electronic health record system. Geisinger’s collaborative culture, ability to recruit and retain the best and brightest professional, and significant investment in advanced technology all contribute to the health system’s ability to develop programs that improve care and provide increased value. 

 

About the position:

Reporting to the Vice President of Network Innovations, the Director is responsible for the day-to-day operations for Provider Network Development and will play a significant role in developing the strategy for this area. The Director must also function on a tactical level, with a “hands on” style and the ability to lead by influence and act as an effective change agent.  A sense of humility, an eagerness to develop authentic inter-departmental relationships and a genuine interest in mentoring the team are all integral characteristics of the successful candidate. 

We are looking for a highly motivated, self-directed and seasoned leader with exceptional contracting and negotiation skills and a keen understanding of medical economics. The ideal candidate will be analytical, strategic, highly collaborative and motivated to join the organization in playing a proactive, forward-thinking role in healthcare reform and the improved delivery of care. Excellent communication skills and the ability to build strong relationships both internally and externally will be critical to this highly visible role. This position offers significant opportunity for advancement and the chance to make some key hiring decisions.    

 

Key Responsibilities:      

 

Network Development:

• Responsibility for the development of the provider network in an effort to meet Sales and Marketing goals and projections by line of business
• Ensure the provider network delivers quality healthcare outcomes and superior medical loss ratios.

• Determination of the most appropriate size, composition and geographic distribution to meet all regulatory standards and member needs.

 

Contract Administration:

• Negotiate complex contracts with hospitals and highly leveraged provider group
• Responsible for implementing strategies and tactical planning to ensure a market competitive cost structure and meet current and future Insurance Operations strategic objectives.
• Enforcement of contractual commitments

• Establishment and maintenance of vendor relationships when necessary.

 

Reimbursement Services:

• Develop tools to effectively evaluate unit cost and utilization trends
• In conjunction with Vice President, leads the development of the next generation of Pay for Performance, Clinical Delivery Models and insurance products that align payment with appropriate care and best practice.
• Develops and implements reimbursement strategies by utilizing reports, reimbursement summary documents, and industry information to conduct review and analysis of unit price, coding practices, and Claim & Reimbursement Policy. 
• Determine appropriateness of provider coding and/or charging practices and associated claims processing payment accuracy to validate actual provider payment against contracted payment terms.

 

Six to 12-month Goals:

• Gain a strong understanding of the geographic and competitive landscape
• Develop strong relationships with direct reports and peers
• Evaluate the structure of the department, assess capabilities of team and make changes as needed 

 

Education and/or Experience:

• Bachelor’s degree in Health Care Administration, Business or a related field required. Master's degree preferred. 
• Ten years experience in managed care operations with extensive knowledge of network development, medical management and provider relations required. Must demonstrate ability to lead and manage significant change activities. 
• Astute financial management skills, including all aspects of operational management.

 

About the City:

Danville is located in northeastern Pennsylvania, a three-hour drive to Philadelphia, New York and Washington, D.C. The area borders the Poconos Mountains, with excellent winter snow and ski activities, sandy beaches and impressive theatres and concert venues. This rural community offers a fantastic quality of life with excellent schools, affordable housing and a variety of outdoor activities. Several golf courses provide ample opportunity for beginners to skilled players.  PPL's Montour Preserve features over 14 miles of hiking and walking trails, picnicking, fishing and boating on Lake Chillisquaque. Additionally, Knoebels Amusement Resort, America's largest free admission amusement park, is located only 20 minutes away and is open from spring through early fall.  See http://www.bloomsburg.org/danville.html for more information.

GHP offers a competitive salary and generous incentive package.  Please review and let me know your reaction. Whether or not you are interested personally, I would love to get your feedback and ideas.  Please contact me directly, or let me know a good time and place to reach you.

Lisa Coyne, Principal

(303) 691-2922

 lisa@morganconsulting.com

 

GEISINGER HEALTH SYSTEM DEPARTMENT OF HUMAN RESOURCES JOB DESCRIPTION

TITLE: Director, Provider Network Development JOB CODE: 1233 FAMILY/GRADE: 99 Executive /8 FLSA: Exempt DEPARTMENT: Geisinger Health Plans LOCATION: System

JOB SUMMARY: Responsibility and accountability for all day-to-day operations associated with Provider Network Development within Provider Network Management (PNM). Direct accountability for Network Development and Reimbursement Services and Contract Administration.  Provides leadership in development of PNM’s strategic plan, budgets, and forecasts, as well as the guidance and assistance of management in the administration and execution of these goals. Develops overall strategy and goals for PNM and Geisinger Health Plan by providing constant, innovative leadership and direction to the development and ongoing monitoring and maintenance of the relationship between GHP and it’s provider network. Strategic planning must be across all product lines. Draws on expertise of other Health Plan’s division staff members as necessary to accomplish goals and objectives and coordinate their participation as it relates to Network Development.  In addition, responsibility includes complete staffing and budgeting accountability within area of responsibility.    Directly accountable to the Vice President, Network Innovations, Health Plans.   MAJOR DUTIES AND RESPONSIBILITIES: 1. Assures the mission, goals and values of GHP are maintained within Provider Network Management. 2. Responsibility for the development of the provider network in an effort to meet Sales and Marketing goals and projections by line of business including: Negotiation of complex contracts with hospitals and highly leveraged provider groups. Determination of the most appropriate size, composition and geographic distribution to meet all regulatory standards and member needs. Development of tight communication processes to other functional areas. Enforcement of contractual commitments. Establishment and maintenance of vendor relationships when necessary. 3. Primary responsibility for the performance of the provider network, delivering quality healthcare outcomes and superior medical loss ratios. Responsible for implementing strategies and tactical planning to ensure a market competitive cost structure and meet current and future Insurance Operations strategic objectives.  Must develop tools to effectively evaluate unit cost and utilization trends.  4. In conjunction with Vice President, PNM leads the development of the next generation of Pay for Performance, Clinical Delivery Models and insurance products that align payment with appropriate care and best practice. Responsible for thinking “outside the box” and providing creative ideas/programs that will increase the competitive position of Geisinger Health System in the market place. 5. Works closely with Director, Provider Relations in an effort to ensure the ongoing satisfaction and long term retention of providers. Develop and adjusts recruitment strategy as necessary.  Facilitates the implementation of provider contracts by serving as a liaison between the provider and health plan’s division.  Facilitates ongoing problem solving and serves as a resource to interpret and clarify contracts related questions and administrative issues. Enhance the visibility and market appreciation for Geisinger Insurance Operations value proposition. 6.  Develops and implements reimbursement strategies by utilizing reports, reimbursement summary documents, and industry information to conduct review and analysis of unit price, coding practices, and Claim & Reimbursement Policy.  Determine appropriateness of provider coding and/or charging practices and associated claims processing payment accuracy to validate actual provider payment against contracted payment terms. 7. Facilitates the matrix working relationship between Network Development, Provider Relations, Reimbursement Services, Contract Administration, and Credentialing.  8. Responsible for human resource issues including such areas as staff coaching/mentoring, staff development, staff competency, productivity, and performance outcome measurement. 9. Serves as the primary liaison in working and guiding Actuarial Services in the development of the necessary analytical tools to drive decision making and support network development activities. 10. Develops strong management communications with Health Plans Senior Management, Sales, Medical Directors, Customer Service, Legal Services and others interacting with PNM.   SKILLS AND ABILITIES: Management skills that include employee management and development and the responsibility for associated budget. Ability to lead and manage significant change activities. Must be results-oriented. Demonstrated leadership, management, facilitation, and networking skills (ability to think strategically) (leadership and organizational effectiveness competencies). Demonstrated project management and data analysis skills. Demonstrated competence in written, oral and electronic communication skills (interpersonal and technological effectiveness competencies) with an ability to lead and facilitate a number of strategic discussions across the organization. Demonstrated ability to work in a matrix relationship.   EDUCATION AND/OR EXPERIENCE: Bachelor’s degree in Health Care Administration, Business or a related field required. Master's degree preferred.  Ten years experience in managed care operations with extensive knowledge of network development, medical management and provider relations required. Must demonstrate ability to lead and manage significant change activities.  Astute financial management skills, including all aspects of operational management.   WORKING CONDITIONS/PHYSICAL DEMANDS: Work is typically performed in an office environment. Independent travel to the sites throughout the system and surrounding communities may be required.   The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.