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Vice President Network Management

Company: Optum
Location: Tacoma
Posted on: September 16, 2020

Job Description:

Vice President Network Management Jobs in Tacoma, WA. Positions in this function are responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation. This includes enterprise wide Clinically Integrated Network teams that focus on specific clinical area Lines of Service (e.g., Cardiology, Women's Health, Oncology, etc.) to improve the quality and affordability through improvements in appropriateness and effectiveness. May perform network analysis and strategy development and implementation. Obtains data, verifies validity of data, and analyzes data as required. Analyzes network availability and access. May make recommendations regarding use, expansion, selection of networks for various products based on that analysis.. Responsibilities:. Owns output of the entire system made up of all related processes.. Drives programs that impact markets of customers and consumers.. Develops, translates and executes strategies or functional and operational objectives at the segment level.. Product, service or process decisions are most likely to impact the entire enterprise, industry, and/or marketplace.. Review/Analyze/Validate/Support Network and Provider Performance Data. Review employer group/health plan expectations (e.g., commercial; government) in order to determine the potential impact to employer group/health plan membership. Gather data from relevant sources in order to respond to stakeholders' requests (e.g., employer groups; internal teams). Analyze network and/or provider performance along key indicators (e.g., compliance with regulatory audits; financial performance; Benefit Cost Ratio; risk adjustment scores; prevalence rates; Unit Cost Reduction Trend) in order to determine which programs to implement and/or modify. Research competitor and external information regarding key network characteristics and contracting strategies in order to develop products and programs. Ensure relevant contract and demographic information is loaded into the applicable platform in order to support analysis and review. Review and/or analyze member/provider population information (e.g., cultural information; demographics; geographic coverage) in order to determine potential network gaps in care and risk adjustment indicator opportunities. Implement new rates with contracted providers based on provider performance. Validate network data for programs (e.g., transparency program). Develop metrics and create performance reports for pay-for-performance programs (e.g., PBC; PCPI). Support/Develop/Drive Effective Network Programs. Determine performance metrics and programs to apply to specific providers based on competitive data, internal data (e.g., provider improvement opportunities) and applicable legal and regulatory requirements. Provide guidance to internal stakeholders regarding administration of contracts (e.g., contract language; coding). Identify needs and create infrastructure and parameters for programs/networks/contracts (e.g., contract language; clinical quality initiatives; internal support). Communicate with key stakeholders (e.g., network management contractors) to ensure programs/networks/contracts comply with standards. Provide input and feedback to senior leadership in order to suggest/recommend. improvements to programs/networks/contracts. Build/Manage Relationships with Network Program Management Stakeholders. Seek feedback from relevant internal and/or external stakeholders regarding potential program/network improvement opportunities and needs. Conduct proactive outreach with external stakeholders (e.g., health care providers; health plan) to demonstrate the value of services and offerings. Collaborate with relevant internal and/or external stakeholders to resolve issues and obstacles with network/program/contract performance. Collaborate with the contracting team to ensure adherence to internal contracting standards. Communicate with applicable stakeholders to provide performance updates regarding program/contract implementation (e.g., objectives; goals; timelines; schedules; issues; performance against standard contract agreements). Follow-up with stakeholders to ensure issues have been resolved and addressed effectively and timely. Manage external relationships with third-party vendors to ensure program SLAs are met.. Demonstrate Knowledge of Program Management Tools, Regulations and Systems. Demonstrate understanding of demographic systems (e.g., Emptoris; NDB). Demonstrate understanding of claims platforms (e.g., Galaxy; COSMOS; NICE; FACETS; Diamond; PPO-One). Demonstrate understanding of report generation and workflow management systems (e.g., ChartFinder; InSite; Sharepoint Documentation; Salesforce). Demonstrate understanding of contracting strategies (e.g., facility; ancillary; physician) in order to support field objectives/MBOs. Demonstrate understanding of key provider/contract/network performance and/or risk adjustment indicators (e.g., prevalence rate; recapture rates; MWOV; RAF scores). Demonstrate understanding of provider group operations and stakeholder/client business models. Demonstrate understanding of documentation and coding procedures (e.g., ICD-9). Demonstrate understanding of applicable health care regulations (e.g., HIPAA; ARRA; CMS). Demonstrate understanding of operations of key business partners (e.g., Clinical Service; Medical Management; Health Care Economics). Required Qualifications:. Bachelors degree required in business or healthcare; Masters degree preferred.. Ten years related experience in medical group or health plan operations with an understanding of managed healthcare or equivalent combination of education and experience.. At least six years of senior leadership experience working with providers and global risk. Data led approach to management. Strong problem solving and decision-making skills. Ability to organize and prioritize multiple competing priorities. A proven track of building and fostering relationships at all levels of the organization. Ability to drive and execute upon organizational priorities. Develop and lead people. Proven ability to collaborate and influence internal and external business partners. Ability to multi-task, detail oriented, excellent communication both written and verbal. Get alerts to jobs like this, to your inbox.. 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Keywords: Optum, Tacoma , Vice President Network Management, Other , Tacoma, Washington

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