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Vice President of Network Development & Provider Services - Las Vegas, NV

UnitedHealth Group


Location:
Las Vegas, NV
Date:
03/28/2017
Job Code:
1735357
Apply on the Company Site
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Job Details


Vice President of Network Development & Provider Services - Las Vegas, NV(Job Number:709108)
Description

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

 

Under general supervision of the Health Plan CEO of the Nevada, Utah and Idaho markets, the Vice President of Network Development & Provider Services position is accountable for the full range of provider relations and service interactions within the Nevada, Utah and Idaho markets. This includes accountability for all provider services programs for all Sierra Health Services lines of business in the Managed Care Division, excluding mental health. Responsibility includes designing and implementing programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers.  The VP plans, organizes, coordinates and administers the network and provider services program yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners.  Position is also accountable for the credentialing, re-credentialing and contracting processes of all health care providers.  Provides direct supervision and development of management and supervisory staff responsible for major administrative divisions, programs and functions.  Indirect supervision provided to professional, technical and support staff within department. Interacts effectively and collaboratively with all departments to gain knowledge and provides information applicable to the benefit plans of Sierra Health Services. Work collaboratively with a dotted line accountability to the Regional VP of Network Contracting.

 

Primary Responsibilities:

  • Responsible for financial modeling analysis, contract evaluation, development, negotiation and implementation, in compliance with company contract templates, reimbursement structure standards, and other key process controls
  • Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
  • Ensures health care provider contracts remain compliant with all federal and state regulations, including but not limited to rules and regulations set forth by the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA)
  • Responsible for provider education and assistance to the health care providers relating to the policies and procedures of the health care plans of Sierra Health Services in the NV market, and for the United Health Care plans for the Utah and Idaho markets
  • Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties, thus positively impacting the health plan provider Net Promoter Score (NPS)®
  • Responsible for end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs.
  • May also be involved in identifying and remediating operational short-falls and researching and remediating claims
  • Provides direct supervision and development of management and supervisory staff responsible for major administrative divisions, programs and functions.  Indirect supervision provided to professional, technical and support staff within department
  • Interacts effectively and collaboratively with all departments to gain knowledge and provides information applicable to the benefit plans
  • Supports and leads by all United Health Group cultural values with both internal and external stakeholders

 


Job Provider Relations and Service
Primary Location US-NV-Las Vegas
Other Location 
Organization E&I Nevada-Utah-Idaho
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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