Develop unit cost trend targets and specific metric improvement for all providers within assigned region to constantly improve overall competitive position and oversee an annual spend of approx.
$500M
– $3B.
Initiatives representing an additional $2M
– $50M in annual cost.
Work closely with other contracting teams to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets, as well as contractual compliance with government relations.
Establish department goals under the leadership of the Network Management and Provider Partnerships executives to ensure alignment of these goals with company’s broader strategic priorities.
Continually review and modify contracting strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches as well as shifts in product design and / or market opportunities, and oversee an operating budget of approximately $1.2M.
Support the Markets organization in the support and acquisition of key employer accounts.
Improve and maintain highly competitive unit costs across all products and in doing so will ensure that a superior provider network is available to all employer groups.
Provide strong and focused leadership to the negotiating team directly accountable for achieving department metrics.
Set up Company and Growth and Health Solutions for long term success through critical organizational initiatives.
Role model collaborative, trusting peer relationships; drive through organization to reduce silos with key business partners.
Identify and develop best in class talent.
Travel up to 20% of the time if living in local market otherwise 50%.
Work with the team to hone leadership skills as well as negotiating skills and technical expertise and help the team develop their ability to optimally utilize internal and external analytical (and other) tools to effectively manage negotiations.
Knowledge, Experience and Education A minimum of a Bachelor’s degree in business, health care policy, public health or related field.
Advanced degree preferred.
Minimum of 10 years provider contracting/negotiation experience at a senior negotiator level, including experience managing complex system negotiations.
Minimum of 6 years of people management experience at a health plan or provider organization.
Understanding of the California healthcare market preferred.
Management experience in leading high performing teams.
Broad and deep health care strategy and overall industry knowledge, and understanding of the California health care landscape.
In-depth understanding of provider reimbursement methodologies and provider contract language.
Demonstrated leadership, change management, collaboration, coaching and mentoring skills.
Demonstrated ability to develop and lead high performing teams.
Excellent negotiation and conflict-resolution skills.
Superior interpersonal skills with the ability to build positive relationships with key internal and external partners.
Excellent verbal, written, and presentation skills with the ability to convey complex information in a manner that others can understand at all levels of the organization.
Strong influence skills.
Superior technical skills in provider contracting strategy, reimbursement methodologies and provider network analysis.
Broad business skills including analysis of strategic alternatives, financial impact analysis and sales experience/exposure.
Excellent strategic thinking, analytical, and problem-solving skills.
Possess a performance and results driven management style.
Ability to work cross-functionally and collaboratively across internal and external teams.
Effective in planning, organizing, and balancing multiple projects and priorities with successful outcomes.