UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Vice President, Network Contracting - Oregon-313783
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.
Develops the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners.Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. -Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff.- Work most often impacts a large business unit, or multiple markets/sites.
The Network Director bears overall strategic and operational responsibility UHN's network regionally, and is responsible for achieving Clinical Network Services goals and objectives (and related objectives of other departments) within their region. The Director develops national strategies in support of network development and maintenance objectives; provides strategic guidance to and supervision over Network Staff under them; and develops efficient and effective workflow processes for network operations across the region. Importantly, the Director is the "go to" Network resource for the entire region. If a Regional Vice President or Medical Director has an issue requiring escalation within or across geographies, the Director acts as the "one stop shop" for the site leader. The Director also is the key point of contact for the Strategic Account Executive as needed on issues concerning the provider network. The Director also ensures the effectiveness of any required regulatory reporting; and serves as the key Clinical Network Services point of contact around any audits within their sphere of influence. The Director continuously assesses the performance of the Network staff under them, and is responsible for both rewarding excellent performance, and for initiating progressive discipline when required. The Director will be expected to work in conjunction with Managers in other regions and functional areas of the department to assure success of the team and unit.
RESPONSIBILITIES:
Targets:
- Responsible for achieving network-related targets as outlined in the Clinical Network Services operational plan for the Network. Including but not limited to regional unit cost targets, access and availability, provider Satisfaction and CAC goals related to network needs.
Market Intelligence
- Working collaboratively with the AVP of Network Ops for Provider Intelligence, develop frameworks enabling Network Specialists to:
- Understand the marketplace(s) assigned-general demographics, major employers, health care delivery trends
- Know the major UHG competitors-both direct sale and health plan-in the areas of question; understand UHG's competitive position within the assigned markets
- Report on specific markets and UHG's network competitiveness as requested
Network Development
- Working collaboratively with the AVP of Network Ops, develop frameworks enabling Network Specialists to:
- Ensure that network size and scope reflects general Clinical Network Services standards
- Utilize competitive information to ensure that the network is market-competitive in geographies of accountability; at least the size of the leading competitor
- Utilize internal information (eg, GeoAccess reports, OON reports, accommodation rates, CAC feedback) to identify specific network gaps
- Achieve competitiveness, standards, and coverage objectives through local development and retention activities; supplement national recruitment strategies with creative, geography-specific strategies to drive availability
Network Management and Retention
- Supervise the Network staff reporting to them; resolve escalated issues as needed
- Working collaboratively with the AVP, develop frameworks enabling Network Specialists to:
- Develop retention strategies within assigned geographies; develop long-term, mutually successful partnerships with providers
- Organize proactive outreach programs to providers, with focus on MDs and high-volume providers
- Act as the primary liaison with administrative and management practitioners to respond to questions, concerns and procedural issues.
- Proactively anticipates problems and provides early solutions or triage issues to appropriate internal expert; act as a liaison for participating practitioners in resolving questions, concerns, and complaints.
- Conduct complaint investigation as warranted or triage to appropriate staff
- Ensure information about network providers is kept as up-to-date as possible in relevant provider systems
- Ensure that practitioners and programs operate within UHG expectations of good care and all contractual requirements.
Support for Other Areas of UHG
- Serve as "go to" lead for CAC, Account Management, and other key UHG leaders for activity within their geographic sphere of influence; triage work to Network Specialists or resolve issues as appropriate
- Serve as "go to: lead for the geographic sphere of influence with respect to audits, regulatory activity, accreditation applications
Develop and maintain strong working relationship with CAC RVP in areas of responsibility; support Care Advocacy issues with providers; support the CAC RVP in achievement of their targets.
Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams. Qualifications At UnitedHealth Group, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Requirements:
- 5 to 8 years in a network management role with accountability for business results.
- 7 or more years of experience in a managed care setting
- 2 or more years of supervisory experience.
- Excellent Written and Verbal Communication Skills
- Presentation Experience
- Computer Proficiency in Microsoft Word and Excel
- Excellent organizational skills and ability to handle multiple tasks and priorities
- Willingness to engage in business travel.
- Masters degree in business, health care management or related field, or equivalent experience.
ALSO:
Excellent knowledge of health care industry. Strong negotiation skills; the ability to gain acceptance from others of a plan or idea and achieve a mutually beneficial outcome. Ability to create and manage a medical cost and administrative budget. Ability to contribute to the development of product pricing. Ability to interpret and take action on trend reporting. Knowledge of Medicare reimbursement methodologies (Resource Based Relative Value System, DRG, Ambulatory Surgery Center Groupers, etc.). Ability to utilize financial modeling and analysis in making rate decisions. In-depth knowledge of the contracting process. Problem Solving skill; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action. Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
Additional Required Skills:
- Leadership: Ability to build a sense of shared purpose and commitment in others
- Strategic Vision and Thinking: Ability to position the organization for the future, looking beyond present situation to conceptualize key trends and identify changing market demands
- Financial Skills and Profit Orientation: Manages the business' overall financial performance, demonstrates strong commercial instincts and identifies profitable opportunities; understands key financial indicators; evaluates strategic choices and options considering financial impact
- Managing Performance: Assists others in setting goals that are challenging and aligned with the broader business goals; monitors and evaluates others' performance, provides feedback, and reinforces behavior
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
