VP Network Management - Washington & Oregon

About the Role

As a member of the Market Growth Leadership Team, the Vice President of Contracting for Oregon and Washington drives innovative provider partnerships, network strategy, and value-based contracting across all states and lines of business – all in service of creating an economically sustainable health care system. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Qualifications

• Master's degree in Business, Health Care Administration, Public Health or a related field and 15 years of broad health care and medical management leadership experience, with at least 7 years of healthcare payer experience, or an equivalent combination of education and experience
• Experience converting providers from fee-for-service to value-based contracts for commercial, Medicare, and Medicaid required

Skills and Attributes

• Demonstrated development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
• Deep expertise in health insurance industry trends, reimbursement methods, and evolving accountable care and payment models
• Broad end-to-end experience with medical care management including product design, provider contracting, utilization management, care management, quality, and go-to-market strategies
• Demonstrated success in contract negotiation and managing relationships with hospitals, provider groups, and integrated delivery systems
• Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise
• Deep business acumen including understanding of market dynamics, financial/budget management, data analysis, and decision-making
• Demonstrated competency in creating and executing business strategies and driving results within a large, complex organization and/or with external partners
• Innovative thinker with the ability to articulate a vision, manage complexity, and lead change
• Strong communication and facilitation skills across all levels of the organization and with executive-level external partners, including the ability to resolve issues and build consensus among diverse stakeholders
• Demonstrated ability to lead high-performing teams and develop leaders

Responsibilities

• Direct the provider network and contracting activities. Lead all aspects of provider network strategy including access analysis, network operations, and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the contracting department.
• Provide executive leadership for Provider negotiation strategy and oversee operational execution in partnership with internal and external stakeholders to achieve stated objectives
• Provide leadership in evaluating opportunities to expand or change the network to meet Company goals
• Partner with company-wide and market-based leaders to develop and execute short and long-range plans related to provider network strategy, contracting, provider satisfaction, quality, and cost
• Ensure networks support affordability, geographic coverage, marketability, and satisfaction goals while maintaining productive relationships between health plan and delivery system leadership
• Champion best practices, innovative healthcare and cost-sharing models, and performance improvement priorities, including developing metrics and reporting protocols to monitor and communicate results
• Partner with Health Care Services and other leaders to create effective new products, programs, and services that achieve marketing, sales, and operational objectives
• Determine appropriate resource needs and allocate resources across departments and projects

Pay and Schedule

Oregon, Washington, Utah, and Idaho: The expected hiring range is $262,650–355,350, the full salary range is $224,000–366,000, and the bonus target is 30%.

This is a hybrid role requiring 3 days per week in office at our Portland, Vancouver, or Renton offices. Candidates should reside within a commutable distance or be willing to relocate. Work from home is available with wired internet requirements (minimum upload 5Mb and download 10Mb, not satellite or cellular).

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits
• Annual employer contribution to a health savings account
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period)
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave)
• Award-winning wellness programs that reward you for participation
• Employee Assistance Fund for those in need
• Commute and parking benefits