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VP of Payer Strategy

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Location: Indianapolis IN

Company Name: American Health Network

Occupational Category: 11-2021.00,Marketing Managers

Date Posted: 2020-02-10

Valid Through: 2020-03-11

Employment Type: FULL_TIME


The Vice President, Payer Strategy will be responsible for planning, directing, and coordinating the policies, goals and objectives related to contract language and rate pricing, negotiation strategy, planning and execution, value based care, and payer strategy. This leader will have an opportunity to have a positive impact on the profitability and future growth of an organization through the implementation of innovative and best practices related to payer contracting.
Essential Functions
+ Influence senior leadership to adopt new ideas, products, and/or approaches, as well as translating highly complex concepts in ways that can be understood by a variety of audiences
+ Actualize OptumCare's core strategy of building of physician-led, value-based, ambulatory care delivery systems by developing and maintaining high value payer partnerships
+ Lead development of comprehensive payer partnership plans in target markets driven by payer value
+ Coordinate development and execution of payer strategies tailored to local market dynamics and OptumCare capabilities

+ Support development of MA global risk model deployment and payer partnerships to realize highest priority opportunity in select markets
+ Partner with physician groups and OptumCare MA team to prioritize markets and develop capabilities to support global risk models
+ Lead senior level relationships with top 2-3 payers in each market to ensure alignment of objectives and viability of models (begin with UHC as proven partner)
+ Provide subject matter expertise to support build out of sustainable and profitable membership growth

+ Support development and lead execution of comprehensive total value of care reimbursement models to drive maximum OptumCare and Payer value incorporating all relevant OptumCare business units and OptumHealth assets
+ Contribute to internal workgroups to craft reimbursement models, conduct analytics, and develop Payer value propositions
+ Partner with key Payer leaders (business and network) in each target market to align with burgeoning pay for value initiatives and competitive positioning objectives
+ Coordinate execution of market strategies tailored to local market dynamics

+ Partner with Ancillary Team to deploy new service lines and payer value drivers within priority markets
+ Incorporate new services lines and related payer value into market development strategies
+ Support deployment of referral management capabilities as a driver of service line adoption and site-of-service value
+ Lead exploration of payer partnership opportunities for high priority service line expansion to address specific pain points and drive value

+ Contribute to development and launch of OptumCare-centered product(s)
+ Lead or provide subject matter expertise to product development effort (resource dependent) in partnership with internal and external constituents
+ Lead partnerships with primary payers to deploy commercial product(s) within priority markets (critical National and Local Market participants)

+ Support development lead market level execution of OptumCare-centered commercial product(s)
+ Demonstrate solid understanding of the payer / provider negotiation techniques including the contract negotiation, renewal, and development process to build and maintain top line revenue strategies, including the foundational principles of provider-oriented management of medical expense risk pools
+ Proactively anticipate and make recommendations to resolve key operational or functional gaps that would prevent the successful implementation of a payer arrangement or product strategy
+ Analyze financial, clinical, and operational data to drive improvements in the contract implementation process
+ Identify new opportunities or services to enhance the capabilities of the National Payer and Network Strategy team
+ Use own proven domain / industry expertise to balance competing priorities in a multi-stakeholder environment
+ Understand all of the latest industry trends around value based contracting, shared savings, and ACO development
+ Possess a good understanding of the healthcare industry from a physician, health plan, and hospital perspective
+ Applies supervisory responsibilities according to organizational policies and applicable laws.
+ Interviews, hires, and trains employees; plans, assigns, and directs work; evaluates and manages employee performance; addresses complaints and resolves employee issues.
To perform this job successfully, an individual must have the following education and/or experience.
+ Bachelor's degree in related field required; and ten-plus years' related experience and/or training; or equivalent combination of education and experience. Master's degree preferred.
+ Minimum of five years senior leadership experience covering a diverse socio-economic workforce.
+ Expertise in two or more health management areas, including population health management, network management, quality, analytics, value based cased, and/or compliance