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VP, Managed Markets, Optum Infusion Pharmacy - Remote

Company: UnitedHealth Group
Location: San Jose
Posted on: March 20, 2023

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

$3B revenue organization delivering home infusion care to 25,000 patients annually across chronic and acute services. Today, Optum Infusion Pharmacy manages 554 contracts with dozens of payers across national plans, regional plans, and at-risk providers. Across these contracts, 15% of revenues are from government programs including Medicare and Medicaid. Most of the contracts today are network service arrangements with medical payers.

The VP, Managed Markets, Optum Infusion Pharmacy is responsible for driving growth and profitability for Optum Infusion Pharmacy through active management of our arrangements with payers and managed care organizations, including health plans, PBMs and at-risk providers. This person will be a seasoned, well-connected leader who is positioned to manage the relationships with payers from start to finish.

You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • National strategic payer account management (UHC + 1-2 additional payers)

    • Manage relationships with large, strategic payers
    • Negotiate 1-2 additional national arrangements
    • Manage master service arrangements
    • Mobilize organization to support expansion of service in line with roadmap
    • Advance innovative arrangements, service models

    • New regional payer contracting and access

      • New contract/ market access strategy
      • Payer relationship development
      • RFP responses
      • New contract negotiation
      • New payer onboarding (incl. client billing orientation)
      • New client set up (clearinghouse, technical)

      • Strategic pricing

        • Manage source of truth for contracted rates
        • Conduct rate analysis, trend reporting
        • Predict go-forward reimbursement trends and impact on price
        • Grow expertise with respect to Medicare, Medicaid reimbursement
        • Maintain ground rules on pricing for new client bids/ renewals
        • Define pricing strategy for high-priority strategic bids
        • Assess pricing impact on OIP gross margin
        • Collaborate with procurement team for gross margin

        • Payer relationship innovation

          • New contract structures
          • Network management activities
          • Network strategies
          • Government program expertise
          • Response to reimbursement regulation trends/ market shaping changes

          • Payer management and support (external facing)

            • Identify growth opportunities from existing relationships
            • Manage renewals, renegotiations for OIP growth
            • Identify and address at-risk contracts
            • Manage contract terminations
            • Manage billing/ collections conversations with payers
            • Performance reporting

            • Contract management and revenue optimization (internal facing)

              • Maintain source of truth for contract requirements
              • Perform internal audits
              • Contract SLA monitoring activities
              • Share/ activate service execution feedback
              • Resolve exceptions and short-term issues
              • Work with Revenue Cycle Management team to identify collections priorities

                Specifically, this leader will be measured on key success factors including:

                • Maintaining broad market access and coverage
                • Establishing 1-2 additional strategic payer relationships on a national scale
                • Advancing our relationship with internal partners such as UHC and Optum Care
                • Managing downward rate pressure and gross margin performance
                • Innovating around network structures and the basis of payment in infusion
                • Mitigating issues with billing and payment, preventing collection challenges and write offs

                  You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
                  Required Qualifications:

                  • 10+ years of experience working in Payer growth leadership roles in the managed markets space
                  • Experience working in the home infusion industry
                  • Knowledge of government payer requirements e.g., Medicare Part B, Medicaid
                  • Knowledge of reimbursement dynamics across pharmacy and medical benefits
                  • Demonstrated evidence managing performance targets
                  • People management experience

                    Preferred Qualifications:

                    • Bachelor's degree

                      To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

                      Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)

                      All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

                      Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado/Connecticut/Nevada residents is $174,600 to $332,200. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

                      Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

                      UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, San Jose , VP, Managed Markets, Optum Infusion Pharmacy - Remote, Executive , San Jose, California

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