DIRECTOR OF NETWORK MANAGEMENT - UC HEALTH

Company: National Community Pharmacists Association
Location: Oakland
Posted on: January 27, 2023

Job Description:

DIRECTOR OF NETWORK MANAGEMENT - UC HEALTH University of California Office of the President Details Posted: 13-Dec-22Location: Oakland, CaliforniaSalary: Open Internal Number: 3716048

DIRECTOR OF NETWORK MANAGEMENT - UC HEALTH

Location: OaklandFull Time
Job ID: 37722
Job Posting

THIS JOB WAS RE-POSTED AND WILL REMAIN OPEN UNTIL FILLED.

For UCOP internal applicants, please login to the internal candidate gateway at: Jobs at UCOP

UC OFFICE OF THE PRESIDENT

At the University of California (UC), your contributions make a difference. A world leader producing Nobel and Pulitzer prize recipients with over 150 years of groundbreaking research transforming the world. Choose a career where you can leverage your knowledge, skills and aspirations to inspire and support some of the greatest minds in the world, and those who will follow in their footsteps. Working at the University of California is being part of a unique institution, and a vibrant and diverse community. At the University of California, Office of the President, we propel our mission through impactful work locally, in government centers and systemwide. We are passionate people, serving the greater good.

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 headquarters to the 10 campuses, six academic medical centers and three national laboratories and enrolls premier students from California, the nation and the world. Learn more about the UC Office of the President

DEPARTMENT OVERVIEW

University of California Health (UCH) comprises six academic health centers, 20 health professional schools, a Global Health Institute and systemwide services that improve the health of patients and the University's students, faculty and employees. All of UC's hospitals are ranked among the best in California and its medical schools and health professional schools are nationally ranked in their respective areas.

Administration and Finance is a department within the UCH Division and part of the immediate office of the Executive Vice President, UC Health. The department provides direct operational support to the EVP, administrative oversight of systemwide finance, and manages internal UC Health division operations, finances, and strategic initiatives.

Our employees embrace diversity, equity and inclusion in all forms. We strive for a community that fosters an open, inclusive and productive environment where we respect the potential of all individuals to make a positive contribution.

POSITION SUMMARY

UC Health's self-funded health plans play a significant role in helping the University retain funds spent on health insurance premiums by both the employer (UC) and employees within its own system. In 2014, the University of California launched UC Care, a self- insured PPO health plan. In 2015, UC Care spent only 7% of each premium dollar on administration compared with 15%-20% spent by commercial health plans. This plan provides medical and pharmacy benefits to UC employees, non-Medicare retirees and their families. UC Health is responsible for the administration of the plan. Beginning in January 2017, UC Health is also responsible for two high deductible and three additional Medicare plans that are self-insured for employees. Total membership in all these plans is about 85,000.

A new self-insured plan for medical residents and graduate fellows s began in the 2017-18 academic year with . total membership about 10,000. There is also a flex-funded employee HMO plan with an enrollment of 125,000 that has an ACO relationship with the UC medical centers. UC Health shares plan administration with Human Resources and provides financial management, population health management and strategic thinking to the medical centers for this plan.

The Director of Network Management reports to the Deputy Health Plan Administrator in UC Health at UC Office of the President (UCOP). Using a high degree of knowledge in network administration, the position works collaboratively as part of a dynamic team, offering expertise, problem-solving, and strategy solutions. The Director is responsible for negotiating and maintaining the relationship with UC providers across the system, including assisting in rate setting, ACO development, access improvement and potentially clinic development. The position may be asked to negotiate direct contracts with providers that are not in the TPA network. This position is expected to determine objectives, direct programs, develop strategies and policies, manage human, financial, and physical resources and function with a high degree of autonomy. Under the direction of the Deputy, the Director will actively assess risks and establish systems and procedures to protect organizational assets. Continual evaluation of the plans is a critical factor for success. Decisions made by this position require consideration of a variety of factors, including an understanding of current business trends.

The incumbent is expected to establish work plans and work collaboratively with a variety of stakeholders. This position manages cross-functional and cross-organizational teams to develop and implement programs while ensuring quality deliverables and outcomes. Problems/issues addressed are of a diverse scope where management of issues or data requires in-depth evaluation of variable factors. The position requires collaboration with a diverse group of colleagues and business partners in a complex organizational structure. The Director must have strong self-initiative and be able to prioritize and complete multiple projects on tight time frames.

Responsibilities

40%

Network Analysis & Strategy: 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. 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. Negotiate direct contracts with providers if necessary. Review claim trend data and/or market information to derive conclusions to support contract negotiations and conduct periodic review of provider contracting rates. Obtain data, verify validity of data and analyze 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.

30%

Negotiate payment strategies with UC providers: Negotiate payment for PPO plans, including developing new transparent payment methodology. Develop new ACO relationship with UC providers for Blue & Gold plan.

25%

Program Design, Compliance, and Implementation: 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. Work closely with key stakeholders on the implementation of applicable quality standards for the networks. Monitors ongoing provider relations and provider satisfaction. Actively builds relationships to identify business opportunities and to generate ideas for business improvement.

5%

Other duties as assigned by the Executive Director

Required Qualifications

• Requires a minimum of eight to ten years of experience and advanced knowledge in health plan network management preferably for self-funded plans. Experience working directly in or with health care institutions strongly preferred.
• Solid experience implementing large-scale/ complex/political change initiatives with demonstrated leadership in business planning, financial planning and analysis and program development required. Proven experience engaging and working in a team environment required. Proven experience in project management, development and facilitation of planning sessions with executives, physicians, directors/trustees, management and consultants desired. Ability to gain cooperation and support through effective use of influence and persuasion required; tact and diplomacy required. Demonstrated customer service focus in all decisions and actions required.
• Ability to work with minimal supervision; self-directed and detail-oriented. Requires the ability to effectively oversee multiple projects simultaneously as well as manage large and diverse teams to deliver results within specified time frames. Ability to supervise and motivate staff and team members to achieve unit and program objectives.
• Proven knowledge of principles and procedures of fully-insured and self-insured/self-funded health plan administration, current literature, trends, and developments in the field of benefit program administration, principles and practices required to develop, implement, and evaluate health and welfare benefit programs, legal regulations applicable to employee health insurance programs (HIPAA, PPACA, CMS, etc.), university policies, procedures, practices, objectives and structure applicable to employee benefits.
• Proven ability to maintain an organized approach, clarity of purpose, and goal orientation in a rapidly changing environment involving multiple stakeholders of various levels from throughout the organization. Strong action planning skills and ability to manage multiple priorities and deadlines.
• Excellent organizational skills with demonstrated ability to manage multiple projects and meet deadlines. Ability to lead and pursue objectives independently while exercising good judgment and exhibiting a considerable degree of creativity.
• Demonstrated experience working collaboratively and influencing across a matrix environment.
• Advanced knowledge of Windows and the Microsoft Office Suite including word-processing, spreadsheet applications, project management and database programs. Excellent time management and organizational skills.
• Excellent ability to quickly evaluate complex issues and identify multiple options for resolution.
• At least 5-8 years ACO experience primarily developing, implementing, evaluating performance, and negotiating contracts.
  Preferred Qualifications
  
  • Proven ability to use original thinking and independent judgment to develop solutions reflecting the legal, policy, and operational needs of the organization; Possesses effective operational thinking and expertise with the ability to analyze and understand healthcare operations quickly to become a trusted advisor or demonstrate in depth knowledge of healthcare operations based on past experience.
  • Proven ability to establish and maintain trust, confidence, and effective working relationships with colleagues and individuals of diverse occupational and social backgrounds. Strong political acumen to intricate situations occurring in a complex, decentralized organizational structure; guide and negotiate complex issues through a hierarchical, bureaucratic organization to achieve resolution.
  • Proven experience working in a rapidly changing environment; must be able to handle pressure and react positively to stressful situations.
  • Experience working in an academic institution desired.
    Education
    
    • Bachelor's degree in Business Administration, Public Health Administration or related field, or any combination of relevant education and experience which would demonstrate knowledge, skill, and ability to perform the essential duties and responsibilities.
      SALARY AND BENEFITS
      
      Salary is commensurate with skills/experience.
      
      Benefits: For information on the comprehensive benefits package offered by the University visit: Benefits of Belonging
      
      ADDITIONAL INFORMATION
      
      HOW TO APPLY
      
      Please be prepared to attach a cover letter and resume with your application.
      
      APPLICATION REVIEW DATE
      
      This job was reposted on 12/5/2022 and will remain open until filled.
      
      CONDITIONS OF EMPLOYMENT
      
      Background Check Process: Successful completion of a background check is required for this critical position. Background check process at UCOP
      
      Smoke Free Work Environment: The University of California, Office of the President, is smoke & tobacco-free as of January 1, 2014. UC Smoke & Tobacco Free Policy
      
      August 2021 Update: The University of California has issued a policy requiring employees to be fully vaccinated against COVID -19 before physically accessing the University location or programs. Upon hire into a UCOP position, you will be provided detailed instructions on how to comply with this policy including access to the COVID vaccination at no cost. New hires to UCOP who work onsite or will come onsite for any activities at a UCOP or other UC location must comply with this policy within 8 weeks after their start date. The policy allows for employees to request approval for an exception or deferral. UC COVID-19 Vaccine Policy
      
      EEO STATEMENT
      
      The University of California, Office of the President, is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status. EEO/AA Employer UC Nondiscrimination Policy
      
      The University of California, Office of the President, strives to make this job board accessible to any and all users. If you have comments regarding the accessibility of our website or need assistance completing the application process, please contact us at: Accessibility or email the Human Resource Department at: epost@ucop.edu .
      
      *LI-SG1
      
      
      
      To apply, visit https://careerspub.universityofcalifornia.edu/psp/ucop/EMPLOYEE/HRMS/c/HRS_HRAM.HRS_APP_SCHJOB.GBL?Page=HRS_APP_JBPST&Action=U&FOCUS=Applicant&SiteId=19&JobOpeningId=37722&PostingSeq=1
      
      
      
      
      
      
      
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Keywords: National Community Pharmacists Association, Oakland , DIRECTOR OF NETWORK MANAGEMENT - UC HEALTH, Healthcare , Oakland, California