National Director of Contracting and Provider Relations

Director Contracting and Provider Relations

The Director Contracting and Provider Relations is integral part of AHF's Care Management Division's leadership team. He or she develops the organization's provider recruitment and retention strategy and tactical plan in support of AHF's California Medicare and Medi-Cal health plans and AHF or Ryan-White funded programs across the United States. He or she leads the Contracting and Provider Relations team based in Los Angeles, California and collaborates with Sales Division in identifying community resources, HIV primary care practices and specialist to aid in the growth of AHF and the Medicare and MediCal health plans networks and services

The Director identifies and recruits practices, health facilities, provider associations, other health care / service providers that will enhance and grow the health plans and AHF networks of care. The Director negotiates competitive and cost-effective contracts with hospitals, nursing facilities, home health agencies, ancillary health service providers, medical groups, independent physician associations (IPAs), and independent providers such that the networks meet enrollee / patient needs and network adequacy requirements of Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC) and Ryan White-funded programs.

To keep the Division's health plans in compliance with contract requirements and applicable regulations, the Director, develops processes in collaboration with the Division's Provider Data Management and IT teams to maintain and verify provider network data so that the plans' provider directories and provider network reporting to CMS, DHCS, and DMHC are complete and accurate. The Director oversees ongoing analysis of the networks in terms of time and distance and develops strategies to address any deficiencies in the networks. The Director is responsible for assuring network adequacy for the Medicare and Medi-Cal health plans

The Director leads the entire provider network growth strategy and tactics for AHF and health plan growth and provider contracting process including network analysis, determining which providers to target, recruitment activities, contract negotiation, provider orientation to the plans and ongoing provider relations to support a seamless provider experience with AHF. The Director demonstrates his or her success in this role by maintaining provider networks that supports organization growth and keeps AHF's plans competitive and attractive to current and potential enrollees and its network primary care, specialty and ancillary health providers, as well as meeting contract requirements and applicable time and distance regulations; keeping network provider data up-to-date, complete and accurate so that AHF can publish accurate provider directories and network reports; and executing financially competitive and cost effective contracts provider contracts.

AHF Commitment

We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment. AHF will consider qualified applicants with criminal histories in a manner consistent with the requirements of the ordinance.