Morgan Consulting Resources, Inc., has been retained to conduct the search for the Senior Vice President of Network Management (SVP) for Arcadian Management Services (AMS), with Corporate offices in Oakland, California.  AMS is the parent company Arcadian Health Plan, which develops, owns and operates Medicare Advantage Plans.

 

About the company:

AMS was founded by John Austin, MD in 1996 as an MSO with operations based in San Dimas, CA, offering services to providers of care.  AMS launched a new product in 2005, Arcadian Health Plan, a national provider of Medicare Advantage health plans.  Through state or locally-branded health plans, they are focused on offering value-oriented Medicare health plan options to Medicare beneficiaries who reside in small to medium-sized communities that currently do not have affordable Medicare replacement plan options available.  They are positioned to attain aggressive growth goals by end of 2010.   As of January 1, 2010, the company will be in 15 states with over 60,000 Medicare Advantage lives.

Arcadian is a privately held company owned by investors including Three Arch Partners, Morgan Stanley, individual investors and senior management.  For more information about Arcadian, please visit http://www.arcadianhp.com or http://www.arcadianmgt.com.

 

About the position:

Reporting to Bob Fahlman, CEO, the SVP we seek will be a seasoned, innovative (yet practical) leader with demonstrated skills in provider relations, managed care contracting and network administration.  The SVP will provide strategic and operational leadership and direction to the Network Management team consisting of Provider Relations, Regional and National Contracting and Market Development.  With three Regional Vice Presidents and a staff of 90, the Network Management team is responsible for the East, Central and West Regions.  The Vice President of Market Development, who is responsible for new market development of providers, also reports to this position.  The SVP will work closely with the CEO as a part of the Executive Management team and will be responsible for developing the strategic business plan with respect to network development and management.  The position carries broad responsibility for leadership and management both internally and externally with the contracted delivery system for all product lines.  The position will be based preferably in Oakland, CA, alternatively in San Dimas, CA, or near a major airport.

The entrepreneurial executive we seek will work collaboratively with care management, compliance, finance, sales and operations to achieve corporate goals and dynamic growth objectives.  We are looking for someone who can think strategically and also be able to “roll up their sleeves” and be involved in facts, figures and details.  He/she will be responsible for:

 

• Overall direction and management of the Networks and the staff within the department of Network Management;
• Assuring adequate provider networks in each new and existing market to support membership growth;
• Managing existing provider relationships to ensure provider satisfaction;
• Working closely with the Medical Management team to ensure the company provides quality health care at an affordable cost (including meeting MCR targets);
• Working closely with Marketing to ensure the company meets or exceeds growth objectives; and,
• Working closely with Medical Economics to ensure appropriate optimization of revenue with HCC and RAF scores.

 

Experience with Government Funded Health Plans is a requirement.  We are looking for a seasoned senior executive who can relate to staff and providers at all levels, including physicians in rural America who have less experience with managed care.  The ideal candidate will possess the strong qualifications shown in the detailed position description attached.

Please let us know if someone you know might be a good match with these qualifications.  The company offers a competitive compensation package, including bonus and equity.  As always, we value your input and look forward to catching up with you soon.

 

Rosie Saenz, Principal                                                      

rosie@morganconsulting.com

(702) 968-8050 office; (702) 561-8226 cell

Full position description follows.

 

 

JOB DESCRIPTION

 

Senior Vice President, Network Management

 

 

KEY RELATIONSHIPS

Reports To:                         CEO

Supervises:                         Regional Vice Presidents – Network Management in East,

                                           West and Central Regions, Vice President National Contracting and

                                           Vice President – Market Development.  Total FTE count:approx. 90.

Other Key Relationships:    Participates as a member of Executive Leadership Team.  Regular interaction with Board of Directors, Chief Medical officer, Health Services staff, Medical Directors, community health centers, network providers

FLSA:                                   Exempt

 

POSITION PURPOSE

The SVP of Network Management will develop the network strategic plan in coordination with the overall company’s strategic plan and will communicate the vision and drive results for the Network Management Department at the Corporate level for all lines of business.  He or she is responsible for the development, implementation and operation of all activities related to Provider Relations, Regional and National Contracting and Market Development. 

PRINCIPAL DUTIES

• Provide organizational leadership for the company as an active participant on the Executive Leadership Team in setting organization direction, strategies, priorities and policies and in working with leadership and staff throughout the organization.
• Foster strong professional working relationships with members of the Executive Leadership Team as well as others throughout the company.  Facilitate collaborative cross-functional information sharing and problem resolution.
• Work with department management, ensure the day-to-day supervision of the Network Management Department including staffing and resource needs, budget preparation, effective hiring, appropriate performance management, staff development, with the goal of developing a cohesive, empowered, and productive work environment.
• Accountable for the company’s performance related to the provider network ensuring organizational compliance with state and federal regulatory bodies.
• Forge strong relationships and continuing communication links with clinical medical directors and providers groups.  Represent the company before professional organizations and promote the company to medical associations and providers in the communities we serve.  Continually evaluates the health care markets and promotes the strategic vision in the local markets. 

 

QUALIFICATIONS

Education and Training:

Minimum of a Bachelor’s Degree, preferably a Masters Degree

 

Prior Related Experience:

Four to six years of senior level administrative experience as a Vice President in a managed care organization, ideally working with Medicare Advantage or government-funded programs. 

Experience in markets in and outside of California managed care.

Knowledge, Skills, and Abilities:

• Good presence and excellent leadership skills with ability to communicate to sophisticated financial audiences.
• Demonstrated analytical abilities and proficient planning skills.
• Effective negotiation skills.
• Demonstrated ability in organizing and inspiring individuals toward pursuit of a common vision and goal.
• Ability to identify systemic issues to promote real change.
• Strong understanding of performance improvement principles and methods, systems thinking and how processes are linked.
• Good eye for and comfort with detail, but an ability to develop and manage high-level plans and strategies.
• Ability to work effectively and collaboratively in a diverse community and workplace through partnering, coaching, and teamwork.
• Strong interpersonal skills with the ability to deal successfully with management, staff, providers, Board members, investors, legislators and other customers.
• Ability to manage difficult provider situations and willingness to constructively confront providers about needed changes in practice patterns in conjunction with the Chief Medical Officer.
• Strong and effective verbal and written communication skills on both an individual and group basis.
• Knowledge of Medicare Advantage Plans.
• Knowledge of QI and HEDIS
• Broad knowledge of CMS rules for Grievance and Appeals
• Knowledge of physician contracting methodologies.
• Ability to maintain a professional demeanor and strict confidentiality.
• Must be able to work with a variety of people at various levels and under sometimes-stressful circumstances.
• Sensitivity to the needs of every individual to be treated with respect and fairness.
• Effectively cope with change and ambiguity.
• Working knowledge of word processing, spreadsheets, and databases (preferably Microsoft products).
• Eligible to participate in state, local, and federally sponsored programs.
• Ability to travel nationally, including overnight trips.