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The Vice President Contracting is responsible for developing the strategy for the product, payor, and revenue growth plans for the Washington market. The position will drive the negotiation process with accountability for the entire process of achieving reimbursement terms that meet Optum objective. They will evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. In addition, this leader will establish and maintain solid business relationships with Health Plans, Payor, and major market insurance brokers and purchasers.
This individual may have direct and indirect reports in multiple locations, serves as a member of the senior management team and has overall accountability for providing leadership, strategic direction and support to all aspects of payor operations and revenue cycle team, to include establishing and maintaining effective professional relationships with internal and external stakeholders. They will formulate and administer policies and procedures, participate in strategic planning and business development activities and assist in the professional development of the contracted operations management team.
If you are located in WA, OR or NV, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Recommends, develops and executes strategic long-range planning as it relates to contracted payors and product participation in support of the market and enterprise strategic mission, philosophy and goals
- Evaluates and makes recommendations for business development and expansion opportunities within assigned territories
- Oversees the implementation of all expansion projects within assigned territories
- Utilize applicable financial tools and reports (e.g., internal financial models; external reports) to evaluate performance of current contracts
- Balance financial and operational impact of contracts to providers, members, payors, Optum Care Network, and different customer groups when developing and/or negotiating contract terms
- Interacts and consults with Network Pricing team to evaluate different financial arrangements and to identify and recommend applicable payment methodologies (e.g., FFS; capitation; Value-Based Care; Pay for Performance) in order to maximize value for stakeholders
- Ensures compliance and consistent contracting across the enterprise
- Evaluates market rates and payor performance in order to establish rate requests and negotiation strategies
- Communicates proposed contractual terms with payors and negotiate mutually acceptable agreement
- Monitors and/or oversee payor performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
- Represents department in internal meetings (e.g., medical management; M&R; C&S, growth and acquisitions) to gather relevant information, present/recommend solutions, and provide updates on results/decision/activities
- Develops and/or implements contracting strategies to support new benefits designs and plans
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.
Required Qualifications:
- 10+ years related experience in managed care contracting with an understanding of managed healthcare or equivalent combination of education and experience
- Solid understanding of clinic financials with the ability to analyze operations and continually implement efficient operational processes
- Proven solid business acumen and proven strategic leadership skills
- Proven ability to analyze complex payer contracts and outline a path to performance
- Proven ability to lead joint operating committees with the payors
- Proven ability to work in a highly matrixed organization
- Demonstrated ability to build and leverage high-impact strategic partnerships through deep, relationship-driven engagement.
- Proven ability to travel up to approximately 25% within assigned market
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $159,300 - $273,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment