The VP, Medicare Network Business will be a thought leader who will be responsible for developing, implementing and drive performance results related to a comprehensive Network strategy for the Medicare segment. S/he will be accountable for achieving all targets and growth goals, as well as driving pricing strategies. This role serves as the key contact point with Market leaders (e.g, SVP, Medicare, Territory leaders and Market Presidents, Medicare GMs) and coordinates with peers across the business. S/he is responsible for setting the strategic direction for network creation and developing future focused enterprise wide contracting strategies optimizing our national network products to deliver profitable growth. This includes but is not limited to, development of contract strategy, negotiation, analysis and administration of all fee-for-service and Value Based contracts at a national level. Additionally, this leader will be responsible for driving an advanced overall Value Based Contract strategy, cost of care initiatives, conducting analysis to identify Medicare expansion opportunities and drive revenue growth by supporting STARS initiatives.
S/he will be responsible for developing the key messages and talk points to the external community and represent the Company at key meetings, conferences, and negotiations. Responsible for contracts with 1.5 million providers, an annual provider spend of $16.2 billion and geographic expansion to over 83% of all eligible counties.
As the National leader, s/he will develop quality, cost competitive networks aligning Medicare products to drive profitable growth. S/he will work across the organization and with Shared Services to create leading edge measurement tracking and root cause analysis mitigating risk exposure and driving enhanced performance. S/he will lead the organization in innovation of payor contracts that advances efforts to move toward more value-based reimbursement while ensuring the financial integrity of the contracts and minimizing risk. Working closely with Medicare GMs and other Medicare leaders, s/he will ensure the successful development of high performing networks and collaborative bid pricing to support segment growth as well as improve medical cost trend.
The leader will foster tighter alignment, integration and shared goals with the Markets organization and our national Network Strategy and Provider Experience organization. Additionally, s/he will manage a diverse team of highly skilled network directors, managers, informatics analysts and other professionals. Role may be REMOTE.
Responsibilities include but are not limited to oversight and leadership of the following:
- Medicare Network Management
- Development of Network strategy
- Accountable for achieving targets, growth goals, medical cost trend
- Pricing strategies
- Serves as single point of contact for Medicare and Markets leadership
- Medicare Expansion and Support
- STARS initiatives and risk adjustment support
- Analysis of expansion opportunities
The role reports to the Senior Vice President of Network Strategy and Provider Experience.
- A minimum of 15 years of healthcare experience including contracting, medical economics and field or national network experience.
- Medicare knowledge will be extremely valued.
- Strategic mind.
- Experience contracting with large national vendors.
- Strong presentation and communication skills; ability to consult as well as negotiate
- Strong analytical skills including root cause analysis
- Skilled at collaborating and working across a complex matrixed organization
Bachelor's degree or equivalent experience
Percent of Travel Required
0 - 10%
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