Posting Salary: Salary commensurate with experience.
Position Summary: Assists with network strategy and contracting initiatives to drive network development and member acquisition, control costs and provide competitive advantages.
Leads network development activities across all campus markets (and other geographies where employees and retirees are located) to include provider negotiations, provider relationships, developing and implementing various contracting strategies and other strategic partnerships.
Participates in managing medical costs of the delivery system and maintaining appropriate access.
Monitors provider satisfaction and network stability across all programs.
Responsible for assuring contractual compliance with policies and procedures.
Monitors financial performance of network.
Develops deep understanding of the UC medical centers, employee needs and future requirements and leverages relationship to create mutually beneficial solutions.
Knowledgeable in current and possible future practices, trends, information affecting the business and leverages the information to create opportunities.
Savvy at leading re-contracting, negotiation processes that achieve a win-win scenario for all parties.
Special Conditions of Employment: Successful completion of a background check is required for appointment to this critical position.
Other Special Conditions of Employment: Successful completion of a background check is required for appointment to this critical position.
Job Close Date: $CloseDate
Perform ongoing network analysis from a cost, coverage and growth perspective. Coordinate network strategies for medical and other providers and services, as well as participation in setting strategy, negotiation and implementation of provider and vendor contracts in addition to reviewing claim trend data and/or market information to derive conclusions to support contract negotiations and conduct periodic review of provider contracting rates.
Evaluate opportunities to expand or change the network to meet UC goals. Analyze network availability and access and make recommendations regarding use, expansion, selection of networks for various products based on that analysis. Solicit, negotiate and maintain network relationships, including successful implementation of executed agreements.
Monitors ongoing provider relations and provider satisfaction and actively builds relationships to identify business opportunities and to generate ideas for business improvement.
Work closely with key stakeholders on the implementation of applicable quality standards for the networks by obtaining data, verifying validity of data and analyzing data as required. Leverage business intelligence and CRM tools to improve decisions. Diagnose quality and revenue/profit shortfalls and proactively develop an action plan to close the gaps and improve results.
Participate in developing successful program design, compliance with network requirements, network assessment and selection and program/product implementation for self-insured plan offerings and ACO's.
Bachelor's degree in related area and / or equivalent experience / training.
10+ years of experience working with a managed care organization, health insurer or consultant in a network management/contract management role, such as contracting, provider services, etc.
Understanding of health care delivery systems and reimbursement models, including self-insured products and ACO's.
Must have excellent interpersonal skills, critical thinking skills, analytical abilities and business skills.
Ability to use good judgement and evaluate situations requiring good decision making.
3+ years of project management or project lead experience and managing matrix relationships.
Must be self-directed and have the ability to successfully interface with diverse personalities.
Strong knowledge of the University environment including its infrastructure, goals, objectives, achievements, rules, regulations and policies.
Willing and able to learn new information and apply that information to different settings.
Advanced ability to convey complex or technical information in a manner that others can understand, including the ability to communicate effectively with various levels of leadership.
About us The University of California, one of the largest and most acclaimed institutions of higher learning in the world, is dedicated to excellence in teaching, research and public service. The University of California Office of the President is the corporate headquarters to the ten campuses, five medical centers and three Department of Energy National Labs and enrolls premier students from California, the nation and the world.
The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age or protected veteran status.
Copyright 2017 Jobelephant.com Inc. All rights reserved.
About University of California Office of the President
The Office of the President is the systemwide headquarters of the University of California, managing its fiscal and business operations and supporting the academic and research missions across its campuses, labs and medical centers.