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VP Network Innovation & APM

Company: Cambia Health Solutions, Inc.
Location: Washington
Posted on: March 18, 2023

Job Description:

VP Network Innovation & APM page is loaded VP Network Innovation & APM Apply locations Seattle, WA Utah Oregon Idaho time type Full time posted on Posted 7 Days Ago job requisition id R-3580 VP Network Innovation & APM Washington, Oregon, Utah or Idaho Responsible for the overall development and implementation of the organization's provider Alternative Payment Models (APM) strategy and roadmap across all states and lines of business. As a member of the Network Management leadership, the incumbent partners with Market Vice President's in meeting and engaging providers and plays a critical role in joint operating committees. The VP of Network Innovations and APMs provides executive leadership and business objective ownership of all LOB Alternative Payment Models. They are responsible for creating and managing all policies and procedures for a wholistic integration with Fee for Service. They apply rigorous monitoring and evaluation, enabling them to successfully track and report on the return on investment of the APM portfolio.The VP of Network Innovation and APM manages a team that conducts ongoing network analysis, monitoring the network against the company's strategic plan, member demographics, utilization, and competitive indicators. In partnership with the Market Vice Presidents, they create, manage, and drive the APM execution plan for integration into market contracting plans.General Functions and Outcomes

  • Own the entire Alternative Payment Model portfolio for both commercial and government programs.
  • Lead the transformation of the APM portfolio by setting a strong vision which the team can translate into an APM Roadmap that encompasses new and innovative models. In partnership with the Innovations team and Regence-wide leaders, translate the vision into executable short- and long-term plans that address existing gaps in our APM portfolio.
  • Partner with Market Vice Presidents in engaging providers. Create and develop trusting relationships and mutual accountability with our provider network. Ensure provider partnerships support goals regarding affordability, geographic coverage, marketability, and satisfaction.
  • Champion best practices, innovative healthcare and cost-sharing models and performance improvement priorities. Ensure there is robust education and communication to provider partners and internal stakeholders to build support and be able to effectively execute on strategic objectives that have strong dependencies upon Alternative Payment Models.
  • Oversee the policies and procedures associated with the APM portfolio ensuring that there is a wholistic integration with fee for service policies and procedures and that the established guardrails are clear and appropriate.
  • Conduct rigorous financial analysis - ensuring the competitiveness of our APM models.
  • Provide NM executive leadership in partnership with market VP for HCA in WA, and other states as required.
  • Creates strong working relationships between all stakeholders within Cambia to include but not limited to HealthCare Services, Strategic Finance, Actuarial and Compliance.
  • Accountable for appropriate resourcing to execute successfully on APM portfolio. Foster an effective work environment and ensure employees receive appropriate communication, recognition and development. Participate in organizational talent management and succession planning.Minimum Requirements
    • Demonstrated success in negotiating contracts and managing relationships with large, complex delivery systems and provider groups.
    • Strong understanding of managed care, capitation, clinically integrated networks and accountable care organizations.
    • Demonstrated financial acumen in provider contracting arrangement on both payer and delivery system sides
    • Deep understanding and proven knowledge of CMS & national quality payment models.
    • Demonstrated competency related to creating and executing business strategies and driving results within a large, complex organization and/or with external partners.
    • Innovative thinker with ability to articulate a vision, manage complexity, and lead change.
    • Demonstrated ability to lead high performing teams and manage and develop leaders.
    • Proven experience in implementing CMMI models such as MSSP, REACH etc.
    • Have experience working with payers (blues and national) on partnership and innovative contracting models with proven outcomes.Normally to be proficient in the competencies listed above:The incumbent would have a Masters Degree in Business or Health Care Administration and 10-15 or more years of broad health care and medical management leadership experience with at least 7 years healthcare payer experience or equivalent combination of education and experience. Finance or Medical training such as a Medical Degree (MD) preferred.The base pay annual salary range for this job is $215,500-$350,500 plus annual bonus.Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association. -If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.
      -At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we rarely hire candidates at or near the top of the salary range. Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:
      • medical, dental, and vision coverage for employees and their eligible family members
      • annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
      • paid time off and company holidays
      • up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
      • up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
      • one-time furniture and equipment allowance for employees working from home
      • up to $225 in Amazon gift cards for participating in various well-being activities for a complete list see our External Total Rewards page. We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required. If you need accommodation for any part of the application process because of a medical condition or disability, please email . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy . As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site. About Us Everyone is a health care consumer deserving of a simpler, more personalized experience. Cambia is transforming the health care system to revolve around people. For over 100 years we've designed people-first health solutions rooted in the nation's first health plan, a loggers' wage pool established in the Pacific Northwest. Today that pioneering spirit aligns our family of over 20 companies, including 4 not-for-profit BlueCross and BlueShield licensed health plans serving over 3 million Americans. Cambia blends data science with a compassionate human perspective to anticipate people's needs, and empower them to make smarter health care choices. Interested in driving accessibility, affordability and quality health care for real people? Apply to any of our open jobs or join the Twitter conversation @Cambia . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy .

Keywords: Cambia Health Solutions, Inc., Saint George , VP Network Innovation & APM, Executive , Washington, Utah

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