Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) The Vice President, Network Management within the Central CA Region develops the provider network (physicians, hospitals, and/or ancillary providers, 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. The Vice President, Network Management - Central CA Region evaluates and negotiates contracts to ensure compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties, in order to meet regulatory minimum network adequacy requirements. Primary Responsibilities: Develop, translate and execute strategies or functional / operational objectives for a region, line of business (Commercial, Medicare, and Medicaid / MediCal)Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiencyDirect others to resolve highly complex or unusual business problems that affect major functions or disciplinesDrive programs that impact markets of customers ranging from providers, employers and/or consumers.Drive and execute Southern California network strategies including strategic partnering with key Tier 1 providersStrong working knowledge of Value Based contracting strategies is critical including experience with ACO'sKnowledge in building new networks and product configurations
Required Qualifications: Undergraduate degree or equivalent experience10+ years of experience in a network management - related role handling complex network providers with accountability for business results10+ years of experience in the health care industry 4+ years of experience in developing of product pricing and utilizing financial modeling in making rate decisionsManagement experience5+ years of experience developing and managing a medical cost and administrative budget5+ years of experience with provider contractingAdvanced level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, Performance Based Contracting, etc.Proven experience executing executive 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 form others, including but not limited to reimbursement policy standards Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: network management, health care industry, product pricing, financial modeling, provider contracting
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.