Director, Ipa Operations Jobs

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

Manage, supervise, and direct the activities of the IPA Administrative Office to facilitate performance of all IPA responsibilities. Including develop/implement budgets and market planning, registration of health plan and provider contracts, computation and distribution of monthly capitation payments to primary care and specialty physicians, adjudication and payment of fee-for-service claims, processing fee-for-service referrals and hospital pre-certification requests. Provide support to Utilization Management/Quality Assurance process; provide management information to group providers. Direct supervision of IPA staff and programs for quality assurance and utilization management, eligibility, claims and encounter processing, network development (contracting and credentialing), health education and provider relations and support of all participating physician and ancillary providers.

Primary Responsibilities:

• Community Relations (Local, regional, chambers, employees)
• Foster interpersonal relationships, showing empathy and understanding towards staff, protecting individual self-esteem. Understand own impact on others; interact effectively with peers, subordinates, and supervisors
• Market Intelligence
• Participate in hospital and cross regional provider contracting which include participation and facilitation of JOCs supporting executive leaders
• Monitor and control work progress. Control allocation and monitor progress of projects, productivity, finances, and materials
• Responsibility for provider and plan member satisfaction
• Work with Medical management teams (UM, QI, credentialing and CM) on program education and implementation of corporate approved and supported programs
• Fundamental knowledge of health plan contracts including DOFR, variances and assist in local implementation if needed. Development of contract terms lives with Payor Contracting
• Overall Influencer & Change Agent (all stakeholders)
• Focus on Geographic Market Assessment (SWOT) & Strategic Plan Development (with VP support)
• Develop and maintain a budget process
• Utilize HCE data to identify potential reimbursement model changes. Responsible to review computation and distribution of cap checks and review claims and encounter data. Manage unit cost for IPA
• Take a lead role in provider management (PCP, SPC) to ensure access, contract, and program compliance including following P&P’s
• Perform local provider contracting and hold JOC’s with support of VPs and provider contracting
• Leadership role in implementing ideas and guiding staff members toward accomplishment of designated tasks and assurance of quality improvement
• PCP/SPC geo-mapping assessment & opportunity spotting
• Manage all IPA growth and sustainability initiatives related to provider and member experience.
• Growth/Retention/Stability
• Delegate work to subordinates, including sharing new information, explaining objectives, clarifying responsibility and authority, and establishing deadlines
• Hospital relationships in support of VP/Sr. executive
• Overall Operations management
• Plan and organize priorities. Establish work objectives; develop procedure or course of action to achieve goals
• IPA P&L (Membership: Growth, Retention. Pt X: Risk Adjustment, Quality, Cost of Care, Network stability)
• Manage and supervise quality and financial performance of the provider network which includes, network development, provider education. Implement plans to achieve budgeted targets
• Fundamental understanding of Physician compensation structure including key performance indicators to drive and articulate performance opportunities/variability
• Business Development
• Relationship Management (Provider/Facility)
• As a triad (ED, RMD and UM) develop tactics and execute on IPA goals in collaboration
• Affordability initiatives – prioritization/direction/collaboration with VP level
• Employee supervision via formal and informal meetings, including performance reviews, assistance with problems on projects. Guide, motivate, coach and train employees
• Provide feedback to Corporate contracting on potential ancillary vendor gaps
• Act as a tactical and strategic partner on access and impact on LOS, Admissions, and Readmissions
• Develop and maintain annual financial and operational performance objectives

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 3+ years Network Development Experience (Provider contracting and recruitment)
• 5+ years of solid experience in the following areas:
• Management of Direct Reports, plus workflow of indirect team members
• Bachelors’ Degree
• Management experience in a matrixed environment
• Negotiation of capitation and fee for services provider contracts
• 5+ years solid experience in the following areas:
• Strategic Business Planning and Implementation experience at a senior level

Preferred Qualifications:

• Excellent oral and written communication skills for both internal and external consumption are a prerequisite
• Broad based background in health care and medical management
• Excellent Customer Care
• Ability to work collaboratively effectively with all levels of employees, management, and stakeholders
• Profit/Loss Statement Management experience
• Managed Care
• 5+ years of solid experience in the following areas:

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)

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.