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Vice President Payer Contracting

Company: Optum
Location: Colorado Springs
Posted on: October 17, 2020

Job Description:

In support of Optum's mission, vision, and strategic goals, this position is responsible for oversight in the corporate Contract Administration function which provides expertise, consulting and administrative support for contracting team who supports network staff.  Reporting to the COO the VP leads the execution of reimbursement strategies, value based contracting, analytics and performance standards to enhance contractual relationships with key multi-disciplinary healthcare partners; leads the negotiation with diverse provider organizations; and ensures that contracting tactics foster efficient and effective implementation through delegated and contracted providers. The VP ensures that execution aligns with strategic objectives coming from leadership

Major Responsibilities Serves as a strategic partner in the development of the corporation’s plans and programs.

Advises the executive team on emerging trends and methodologies in managed care contracting, payer relations and legal issues.

Develops overall payer and network contracting strategies for business growth, maximum revenue and maximizing the organization’s competitive cost structure.

Negotiates new contracts to ensure maximum revenue and operational efficiency and compliance.

Establish the department's strategic vision, objectives, and policies and procedures.

Develop, implement and maintain production and quality standards for the Contracting department.

Work with Operational leaders to ensure effective implementation and adherence of payment and authorization practices.

Establish and maintain effective business relationships with network providers on behalf of the organization.

Perform periodic analyses of the provider network from a cost, coverage, and growth perspective.

Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy.

Analyze claim trend data and/or market information to derive conclusions to support contract negotiations.

Work with Managed Care providers and other representatives to resolve contractual issues.

Support market expansion and MA activities by leading provider contract analysis related to due diligence.

Oversees the creation and implementation of contracting training programs for network staff.

Collaborates with legal to create non-standard contract language when needed to support field contracting efforts.

Provides consulting, negotiations and contracting expertise to field network staff as needed.

Participates in or support hospital and multi-site ancillary provider contract negotiations as needed.

Participates in or support network development for new markets as needed.

Performs all other related duties as assigned.

Qualifications

Knowledge:

Significant knowledge of provider contracting and reimbursement arrangements.

Solid understanding of medical care delivery and financing arrangements.

Skills/Abilities:

Ability to engage directly with senior level executives (e.g., CEO President, etc.).

Strong influencing skills, track record of successful client relationship development and ability to quickly build credibility and gain the confidence of individuals at all levels.

Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives and other health plan staff.

Excellent analytical and problem solving skills with effective follow through.

Strong verbal and written communication skills.

Proven contract negotiations skills.

Demonstrated ability to lead a service function through influence management skills in a matrix management environment.

Experience:

10 + years network development, provider negotiation and contracting experience involving physicians, hospitals and ancillary providers, including five or more years at the manager level or above.

Education:

Bachelor’s degree in Business, Healthcare Administration or related field required.

Master’s degree in Business, Healthcare Administration preferred.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work. (SM)

Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Optum, Colorado Springs , Vice President Payer Contracting, Other , Colorado Springs, Colorado

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