SVP Network Strategy and Performance

at  UPMC

The Senior Vice President, Network Strategy and Performance will report directly to the President of the Insurance Services Division. This highly visible business leader will play a key part in achieving UPMC Health Plan’s strategic growth objectives, as well as expanding our provider network capacity to support product diversification and client requirements. This position will lead the strategy and development of provider networks in Pennsylvania and nationally and ensure a high quality, engaged, and cost-effective network capable of serving both fee for service and risk/alternative payer contracts. This position includes the development of contracting strategies and contractual relationships with providers, ensuring timely and cost-effective negotiations/renegotiations of provider reimbursement rates and contracts. In addition, this position will be responsible for the strategy and implementation of all alternative value-based payments.

• Direct the negotiation/renegotiation of all hospital, physician and ancillary payment rates.
• Create, negotiate and implement value/risk based agreements with hospital, physician, and ancillary providers focused on quality, efficiency and revenue optimization.
• Work with IDFS colleagues to create best in class fee for service and value/risk based contracting methodologies.
• Create homegrown analytics to support value/risk based contracting programs.
• Develop, coordinate, and maintain a network expansion strategy that supports growth and expansion needs for all UPMC HealthPlan products.
• Develop and maintain effective communications with all impacted areas.
• Lead Reimbursement, Contracting and Network Development teams.
• Ensure excellent service to providers.
• Ensure team integrates with and supports other internal divisions as necessary.
• Responsible for entire network management function of dental and vision network, and responsible for the maintenance of ancillary provider network.
• Direct the ongoing analysis and comparison of reimbursement schedules to ensure market competitiveness.
• Ensure that a comprehensive national provider network is established and maintained to meet growing client and business demands, as well as market expansion.
• Partner with internal resources (Health Services, Quality, Sales, etc.) to analyze medical trends in order to deliver high quality/large provider networks that support initiatives in achieving market growth and budgeted MER costs.
• Lead the development of standardized contract documents for individual providers.
• Collaborate with finance, clinical operations, human capital, legal, and other internal operational areas to develop and monitor provider compensation and incentive models.
• Lead the provider orientation process as institutional providers join the network.
• Develop and execute market-specific network contracting strategies. This includes identifying and cultivating strategic alliances and building new network models with significant provider organizations to ensure that the healthcare needs of UPMC Health Plan members and clients are met.
• Ensure compliance with all requirements related to regulatory, accreditation, and operational performance.
• Collaborate with business development and product development to ensure that provider development efforts reflect current and future payer and product strategies.
• Ensures that all provider support functions take a proactive approach to addressing emerging business activities in order to remain competitive within the marketplace.
• Bachelor’s degree required; Master’s degree strongly preferred
• 10-15 years of executive management experience with either a health insurance company, physician practice, hospital, or integrated delivery system is required.
• Strong track record in network development, reimbursement, and network performance analysis.
• Deep expertise of coding and related governmental guidelines and provider reimbursement methodologies.
• Prior experience developing and implementing value-based payment models and contracts.
• Excellent communication with verbal, written, and presentation skills.
• Experience negotiating and contracting providers on a national level.Ability to work cooperatively with multidisciplinary teams and/or independently.
• UPMC is an Equal Opportunity Employer/Disability/Veteran