VP, Contracting & Regulatory Affairs Health Integrated
THIS JOB HAS EXPIRED Description
JOB SUMMARY: The VP, Contracting and Regulatory Affairs is responsible for negotiation of new and renewing customer contracts as well as the development and maintenance of standard and customized client and vendor contract language related to performance measurement and reporting language. This individual also develops, organizes, and maintains all documentation that supports regulatory compliance with state and federal requirements to insure continued compliance with regulations governing our business lines. This position will not conduct any activities that require evaluation or interpretation of member specific clinical information. This positions is accountable for maintenance of the provider credentialing process.
Education/License/Certification: BA, BS Degree or other College degree required
Experience: Minimum 8-10 years experience working in the healthcare industry, knowledge of regulatory environment, healthcare trends, industry standards, and insurance regulations, a law degree with 4 years experience in these areas may be considered an adequate substitute for the experience level. Knowledge of general contract review and legal terminology a requirement.
Strong logic, time management, documentation, and problem solving skills are essential.
Excellent communication skills, both written and verbal.
Ability to quickly gain an understanding of new program platforms, tools, resources, and policies and procedures and make recommendations for change when opportunities for improvement or problems are identified; and to document these items in contractual terms.
Strong understanding of Federal/State laws affecting products and services of Health Integrated and the ability to identify and communicate the impact of those laws on company operations.
Ability to read, interpret and negotiate contracts; ability to work with clients and outside counsel.
Excellent computer skills.
This position owns the contracting process for all client, vendor and outside resources; and
is accountable for insuring contract commitments comply with corporate standards and reasonable business practices or have been authorized by appropriate senior executives; and
is responsible for the state and federal compliance processes; and
is responsible for the network credentialing process; and
is responsible for controlling and compliance with investor due diligence and contracting needs as determined by the CFO
This position is responsible for State and Federal regulatory compliance of the company related to clinical and corporate functions.
Analyze appropriate laws, judicial decisions, legal articles, and other relevant materials to ensure compliance, support sales efforts, product development and other corporate initiatives.
Educate staff on laws and regulatory standard requirements
Responsible for obtaining and managing state certifications and licensures as warranted by marketing/sales efforts
Submit Material changes to Utilization Review Policies and Procedures to states within specified time frames
Ongoing development, organization, and maintenance of program documentation to reflect Compliance with all state/federal laws
Identify changes in healthcare regulatory environment and communicate those changes to appropriate individuals/departments.
Development and maintenance of regulatory compliance reference materials.
As a member of UM Committee, present regulatory issues to committee on monthly basis.
Coordinate annual reporting to state agencies regarding UR activities.
This position is responsible for leading organization?s contracting process with respect to drafting, reviewing, interpreting, and negotiating contractual documents to minimize risk, maximize revenue potential for Health Integrated and ensure that there is a consistent understanding of contract terms and conditions between the parties.
Develop, manage, and review contract management processes to insure all contracts receive appropriate review and sign off of issues.
Drives resolution of conflicts arising in the contracting process with regard to service descriptions; guarantees; or other issues.
Advise leadership with respect to negotiation efforts and associated business risk.
Work with appropriate internal staff to insure client and vendor arrangements are contracted to conform to HI standards where they exist and that contractual commitments reflect appropriate standards of performance.
Insure all client, vendor, and consulting contracts to ensure legal compliance and consistency.
Ensure contract process adherence company-wide.
Drive accurate and complete responses to due diligence efforts related to mergers and/or acquisitions in a timely manner with a goal of maximizing corporate value
Minimize to the extent possible, referral to outside counsel without compromising the expertise that may be necessary in certain individual matters.
Oversees and ensures compliance of the provider credentialing process
||10008 North Dale Mabry |
Tampa, FL 33618
THIS JOB HAS EXPIRED