Vice President, Network Innovation & Operations

Vice President, Network Innovation & Operations

Portland or Remote

This role is responsible for the overall development and implementation of the organization’s provider innovation contract portfolio, including value-based programs and Accountable Health strategies across all states and lines of business. Responsible, in a matrixed organization, for network adequacy, efficiency, effectiveness of contract implementation and continued provider satisfaction. Manages a team that conducts ongoing network analysis, monitoring the network against the company’s strategic plan, member demographics, utilization, and competitive indicators. Participates as a member of the Network Management Leadership Team to drive integrated business strategies. Responsible for driving successful execution of short, medium, and long-term Cambia business objectives that require innovative provider collaboration. Provides leadership to maintain and evolve effective provider partnerships. Ensures our provider partnerships support health insurance product and enrollment objectives and moves providers away from fee-for-service and toward deepening levels of fee-for-value. Drives provider partnership innovation strategy, execution, and key metrics, working closely with the VPs of Network Management in our four state market regions to optimize overall provider strategy.

General Functions and Outcomes:

• Provide executive leadership and overall direction for Provider Partnership Innovation strategy and operational execution, confirming overall direction and tactics and in partnership with all essential internal and external stakeholders in the achievement of stated objectives.

• Partner with Regence-wide and market-based leaders to develop and execute short and long-range plans, goals, and objectives related to innovative provider partnerships, in support of overall provider network strategy, contracting, provider satisfaction, quality, and cost. Ensure provider partnerships support goals regarding affordability, geographic coverage, marketability and satisfaction.

• Ensure overall productive relationships between health plan and delivery system leadership. Create provider-related metrics and reporting protocols specific to value-based reimbursement models. Monitor and communicate results. Lead the development of interventions to continually improve and maintain long-term competitive position and profitability.

• Champion accountable health best practices, innovative healthcare and cost-sharing models, and performance improvement priorities. Ensure there is robust education and communication to provider partners and internal stakeholders to build support and be able to effectively execute Provider Partnership Innovation strategic objectives.

• Partner with Health Care Services and other leaders to create effective new products, programs and services that achieve accountable health marketing, sales and operational objectives.

• Determine appropriate resource needs and allocate resources across Provider Partnership Innovation team and projects.

• Foster an effective work environment and ensure employees receive appropriate communication, recognition and development. Participate in organizational talent management and succession planning.

Minimum Requirements:

• Expertise related to health insurance industry trends, reimbursement methods and evolving accountable care and payment models. Broad end-to-end experience with value-based contracting, such as product design, provider contracting, utilization management, care management, quality, and go-to-market strategies.

• Demonstrated success in developing and managing strategic, executive-level relationships with, provider groups and integrated delivery systems.

• Deep understanding of how providers and healthcare systems function. Practical knowledge of the financial challenges that face providers and ways to partner with them in mutually advantageous arrangements. Sophisticated understanding of how healthcare is delivered by providers.

• Expertise in quality metrics and what truly drives quality outcomes. Understanding of how national payers such as the Centers for Medicare & Medicaid Services approach quality. Knowledge of national quality payment programs that are familiar to providers.

• Strong communication and facilitation skills with all levels of the organization and executive-level external partners, including the ability to resolve issues and build consensus among groups of diverse stakeholders.

• Deep business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making. Strong analytic skills.

• Demonstrated competency related to creating and executing business strategies and driving results within a large, complex organization and/or with external partners.

• Innovative thinker with ability to articulate a vision, manage complexity, and lead change.

• Demonstrated ability to lead high performing teams and manage and develop leaders.

Normally to be proficient in the competencies listed above:

The incumbent would have a Masters Degree in Business or Health Care Administration and 5 or more years of broad health care and medical management leadership experience with at least 2 years healthcare payer experience or equivalent combination of education and experience. Medical training such as a Medical Degree (MD) preferred.

FTEs Supervised:

Approximately 7 direct, 26 total

Work Environment:

Work primarily performed in an office or home office environment

Travel required, locally or out of state.

The post Vice President, Network Innovation & Operations first appeared on Oregon Job Market.

from Oregon Job Market https://ift.tt/3b5QMhm
via IFTTT