If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)
The VP of Provider Owned ISNP Product will lead and build the overall start-up development and operational strategies for a new business line product within Complex Care Management. Responsible for selling this customized product to provider owned ISNP health plans. Design, develop and lead functional areas and processes that support external health plans. Some of these may be total start up health plans or acquisitions. End to end management of external vendors or internal Optum resources (Actuarial, Consulting, Network Build, Sales ops, Model of Care, Quality, compliance, etc.) in support of one face to the external health plan. Manages product performance against expectations and facilitates or influences changes to product portfolio to improve competitive position and optimize product performance. Anticipates future needs to drive existing and new product development and innovations to meet ongoing performance standards and demands of business growth. Works in collaboration with Care Services leaders and external business constituents to determine product design and strategy.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Provides leadership, accountability, and responsibility for the overall oversight and performance of the External Provider Owned ISNP product organization
Manages the relationships and external vendors that support this business for external ISNP’s
Optum Actuarial and the bid and benefit CMS filing processes for the external plans
Manages deliverables from an external TPA, claims processing for the plan with oversight of all processes required of the TPA including mailroom, check writing, call center member materials, sales operation and application processing
Coordinates the Model of Care filing with Optum Consulting for each plan contracted and then monitors oversight to the execution of the Model of Care
Monitors oversight to the Appeals and Grievances and Utilization management for each plan
Oversee the network build to meet CMS compliance for start up health plans to achieve approval and licensing from CMS
Creates a successful Product Roadmap for the product to achieve goals around growth, revenue, profit and return on investment for all of the channels / categories of the product and/or key external customers
Develops processes for all end to end functional needs to support and operated an external ISNP program. This includes member eligibility and systems, member sales and operational support of applications to CMS, eligibility to claims systems, network management and contract loads into claims platforms, model of care filing and management, underwriting and actuarial, clinical risk, reporting, performance, Appeals and Grievances, Utilization Management, Member and Provider call centers and portals
Reviews product performance against expectations and facilitates or influences changes to product portfolio to ensure optimal performance
Understands and drives product requirements (from market and clients), overall value, reporting, performance, product roadmap / evolution (enhance, expand, maintain, sunset) to drive product strategy that aligns with market dynamics and growth expectations
Demonstrates understanding of market trends and competition to ensure appropriate product position and growth
Lead and oversee product development and management including creation, development, and implementation of innovative solutions driven by trends, customer needs and ongoing operational needs within Care Services
Understands market stakeholders to ensure value at each level- clients, consumers, providers, regulators, accreditation, Optum / UHG, others
Drives growth, and go-to-market strategy, individual client deal strategies; serves as product subject matter expert
Identifies acquisition and partnership targets that align with Care Services product and growth opportunities
Facilitate the design and build of end to end operating and clinical models for this new business product for end to end operations for provider owned ISNP health plans
Builds relationships with key matrix partners and executes on product delivery to ensure alignment with Optum, and other business units to achieve seamless execution and service delivery for the external health plan client
Stands up the new product and then develops strategy for growth of the external health plan
External ISNP relationship & account management- P&L- Risk based contracts
Long term care Industry changes- awareness to product development / change
Interface and coordination with network and clinical and sales teams
Business Process Improvements
Market performance end to end for the client external health plan.
Own the P&L for this product
Anticipate contracting with a minimum of 3 health plans in the next 2 years and grow the product to over 5 health plans in 5 years with potential membership of 15,000
Undergraduate degree or equivalent experience
5+ years of senior level executive relationship management experience
5+ years of experience in driving deep, productive relationships with senior-level client executives
Sales experience working with senior leadership in identifying, accessing, developing, constructing, presenting, negotiating, closing, and managing large deals in healthcare
Experience and expertise in the health system market
Experience analyzing complex market opportunities and developing creative solutions to a wide variety of unique market problems
Experience with message, position and present information for client impact and influence
Experience operating and effectively navigate in a highly complex, matrix environment; successfully negotiate complex internal operating environments with a high level of collaboration
Experience with active collaboration, engagement, oversight and strategy development of key growth opportunities
Experience interacting at the C-Suite level to cultivate relationships and partnerships
50% travel as required
Advanced degree (e.g., MBA, MHA)
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.
Job Keywords: VP of Provider Owned ISNP Product, Telecommute, Remote, Work from Home