These two roles provides executive leadership and direction to the Provider Services organization for the Idaho and Oregon state-wide markets. Leads and drives the development and execution of holistic provider strategies (including fee for service contracting, value-based arrangements, Cost Stewardship, etc.) that support both Regence-wide and state-specific objectives. Oversees contract negotiations and provider relations. Develops and maintains key strategic relationships and partnerships with providers across the states in service to key business objectives. Ensures there is appropriate provider network breadth and stability to support product and enrollment objectives.. Serves as a key leader in the market alongside the Market President, VP of Sales in the state markets, and Executive Medical Director, both within the community as well as with the local market team. Responsible for helping to grow membership within the markets for all lines of business.
General Functions and Outcomes
Partners with Cambia-wide and market-based leadership teams to develop and execute short and long-range plans, goals, and objectives related to network strategy, provider satisfaction and cost. Ensures networks support goals regarding to affordability, geographic coverage, marketability and satisfaction. Works closely with market Presidents to grow membership and the provider network.
Develops and oversees effective local market contracting strategies and execution including forecasting expenditures, managing to budget targets, and regulatory compliance.
Ensures productive relationships between Regence and delivery system leadership. Monitors provider related metrics and satisfaction results and leads the development of interventions to continually improve.
Oversees communication to providers in order to build effective partnerships and ensure compliance with contractual provisions and regulatory requirements. Provides an executive presence within the market as needed to support other relationships such as those with purchasers, brokers, agents and consultants.
Determines appropriate resource needs, creates and manages department and/or project budget, allocates resources, and approves expenditures.
Manages the Provider Services organization through fostering an effective work environment and ensuring employees receive appropriate communication, recognition, and development. Participates in organizational talent management and succession planning.
Demonstrated success in negotiating contracts and managing complex relationships with hospitals, provider groups, and integrated delivery systems that include fee-for-service contracts, strategic value-based arrangements, and other provider partnership initiatives.
Strong knowledge of health insurance industry trends, reimbursement methods, and evolving accountable care and payment models.
Demonstrated ability to coach, develop and motivate others, lead high performing teams, and manage managers.
Strong communication and facilitation skills with all levels of the organization and executive-level external partners, including the ability to resolve issues and build consensus among groups of diverse
Proven ability to build collaborative, strategic relationships with a variety of people and personality types, both inside and outside the company. Comfortable working in a matrix environment.
General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making.
Demonstrated competency related to creating and executing business strategies and driving results across internal teams and/or external partners.
Normally to be proficient in the competencies listed above:
VP, Network Management would have a Bachelor's degree in business or healthcare administration (Masters preferred) and 10 years relevant management experience, including 5 years of negotiating contracts, or equivalent combination of education and experience.
3-5 direct reports; 10-25 total team members
No unusual working conditions
Travel may be required, either locally or out of state
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. We are an equal opportunity 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 drug screen and background check is required.
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.
Internal Number: R-648
At Cambia, we advocate for transforming the health care system. You aren’t satisfied with the status quo and neither are we. We're looking for individuals who are as passionate as we are about transforming the way people experience health care. We offer a competitive salary and a generous benefits package. We are an equal opportunity 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 drug screen and background check is required.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. We have over a century of experience in developing and providing health solutions to serve our members. We had... our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future.