About Us

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Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

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Our Core Values are:

\n\nWe serve faithfully by doing what's right with a joyful heart.\nWe never settle by constantly striving for better.\nWe are in it together by supporting one another and those we serve.\nWe make an impact by taking initiative and delivering exceptional experience.\n\n

Benefits

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Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

\n\nEligibility on day 1 for all benefits\nDollar-for-dollar 401(k) match, up to 5%\nImmediate access to time off benefits\n\n

At Baylor Scott & White Health, your well-being is our top priority.

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Note: Benefits may vary based on position type and/or level

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JOB SUMMARY:
VP Network & Member Services is responsible for planning, developing, and growing the provider network and member services for the health plan of Baylor Scott and White Health (BSWH), which may include provider network development, contracting, credentialing, and provider relations. Responsible for all aspects of the health plan provider network development, including provider research, policy development, contract development, provider solicitation, provider call center and expansion of the provider network including physicians, hospitals, allied health providers, other ancillary providers. Develops and implements strategies, policies, programs, and procedures to develop the health plan provider network and member services, including the member call center, ensuring strong provider interaction, member interaction, provider network growth, and enhanced provider and member relations. Creates medical delivery objectives that align BSWH Health Plan, members, physicians, and medical facility interests. Directs and monitors network performance and quality, coordinates provider network communications, oversees provider orientation and education, and leads resolution of provider and member issues. Develops relationships with internal and external physicians, administrators, healthcare delivery system leaders, and other stakeholders to strengthen and grow programs of the BSWH network. In addition, oversees the responsibility of the pricing, configuration, provider data and audit function (the provider data integrity unit).

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ESSENTIAL FUNCTIONS:
- Oversees the network development, member services and management functions for the health plan of BSWH.
- Develops and implements network development plans and priorities that align health plan, member, physician, and medical facility interests in accordance with overall business objectives of BSWH.
- Develops relationship models that address critical success factors for the organization across various practice types, such as group, independent, and hospital-based practices.
- Oversees the successful formulation, development, and implementation of reimbursement arrangements that align medical delivery system with quality, outcome, and expense objectives.
- Leads operational aspects of network development and contracting, including information gathering, negotiation, implementation, and reporting through provider relations and network management activities.
- Ensures that all contracts comply with the operational, quality, and legal requirements of the health plan, and modifies contracts as the health plan business needs and membership changes.
- Leads the implementation and negotiation of provider contracts of all network providers.
- Ensures that all contract processes, policies, and workflows are optimally designed to maximize efficiencies and reflect industry best practices.
- Leads the development and implementation of an audit program that resolves issues and errors and adjusts to developing market conditions.
- Oversees the network development contract audit processes to ensure consistency between contract terms and adjudication of authorizations and claims.
- Oversees the Provider Services and Member Services call centers to ensure a customer centric focus for member and providers.
- Oversees the Provider Data Integrity Unit (pricing, configuration, provider data and audit) to ensure the accuracy and completeness of provider set up and implementation.

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KEY SUCCESS FACTORS:
- Bachelor's degree in business, healthcare administration, or related field preferred. Master's degree preferred.
- 7+ years of experience in healthcare network development, provider relations management, or related area.
- 5+ years of experience in a leadership role.
- Experience and understanding of network development in a health insurance plan.
- Strong understanding of the financial and strategic impact of provider contracts and network affiliations in a health care delivery marketplace.
- Excellent financial analysis skills.
- Strong collaboration and negotiation skills.
- Excellent written, verbal, and presentation skills.

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Belonging Statement

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We believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve.

MINIMUM REQUIREMENTS:
- Bachelor's or 4 years of work experience above the minimum qualification
- 7 years of experience