Vice President, Network Programs – Seattle, WA or Telecommute in Pacific Northwest only

Position Summary: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 marketplaceCompetencies: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/contractsBuild/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 metDemonstrate 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)You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.You’ll enjoy the flexibility to telecommute* from the Pacific Northwest as you take on some tough challenges.Required Qualifications:* 10 years of experience in medical group or health plan operations with an understanding of managed healthcare* 10 years of experience in a combination of the following: provider network, contracting, quality, regulatory, credentialing and/or data/analytic operations* 3+ years of experience within Medicare and Medicaid* 6+ 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 be based in the Pacific Northwest (willing to relocate for the ideal candidate)* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking ordersPreferred Qualifications:* Bachelor’s & Master’s degree* Experience with CSP Facets* Direct experience in hospital, ancillary and physician contracting* Experience working with Commercial marketsOptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.* All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Colorado Residents Only: The salary range for Colorado residents is $169,500 to $322,500. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, in addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employmentJob Keywords: Vice President, Network, Provider, Healthplan Operations, Leadership, Quality, Contracting, Managed Care, Pacific Northwest, WA, OR, Telecommute, Telecommuter, Telecommuting, Work from Home, Work at Home, Remote, Seattle, Spokane, Tacoma, Olympia, Bellevue, Washington