Vice President, Network Relations and Quality Improvement
General Statement of Duties
This position is responsible for leading quality improvement, network and provider strategy, and execution for related network services across the organization. The majority of time is focused on enterprise-wide engagement, with secondary time on business group oversight. Primary duties include strategic planning and operational effectiveness, as well as development and oversight of resources, network relationships, and teams. This position actively and regularly participates in strategic planning and collaboration with internal CareOregon teams, Lines of Business (LOBs) and Network partners.
Essential Position Functions
Provides strategic leadership for network services activities across the organization in support of Medicaid, Medicare, and other populations; additionally, provides leadership for HEDIS and Medicare Stars work.
Ensures the development and maintenance of provider relationships in alignment with our mission in order to facilitate highly effective clinical care for members.
Oversees intake and initiation of clinical/metric components and development of network support related to value-based payment initiatives that assures CareOregon is strategically positioned to support its current and future provider network and strategic partners.
Oversees the development of quality payment strategies and within CareOregon networks.
Oversees the development and deployment of network based resources to ensure CareOregon meets CCO, HEDIS, and Medicare and other related metrics.
Provides oversight to ensure timely and accurate network related regulatory submissions and requirements. Working in conjunction with Customer Experience, IS and other key CareOregon teams help lead this work, examples include Delivery System Network (DSN) submission, Provider Directory needs
Ensures the development and deployment of reporting and analytics utilized in the provider network, including the analysis of alternative payment model programs.
Develops and leads a model for governance, ensuring understanding and alignment across intersecting departments, matrixed relationships, and external partners.
Participates in quality and other functional Committees.
Participates in the development of organization evaluation strategy and structure.
Ensures internal systems and measures are in place to enhance effective, efficient, and compliant operations.
Identifies performance metrics; ensures the timely and accurate monitoring and reporting of performance against metrics.
Promotes innovation, process review, and refinement.
Serves as a sponsor for key projects and initiatives.
Leads the development of vision and goals for network relations, network support and network-based performance metrics.
Develops and refines strategic plans in alignment with organizational vision and goals.
Defines operational structure for areas of oversight and approves policies.
Participates in the strategic planning process for the organization.
Maintains an enterprise view while establishing business unit priorities.
Develops budgets in alignment with strategic planning.
Ensures teams have sufficient resources to perform their work.
Ensures budgets are monitored and managed effectively across areas of oversight.
Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.
Ensures strategic messages are regularly and effectively relayed to management team and staff; promotes transparency.
Leverages current relationships and forges and leverages new relationships with community partners, provider networks, and other constituents in alignment with organizational direction and priorities.
Collaborates with leaders across the organization in identifying integrated improvement strategies and ensuring meaningful integration.
Represents the organization in external meetings and functions, providing strong leadership presence and effectiveness.
Directs teams and establishes team and management direction and goals.
Provides team members with ongoing understanding of the strategic direction of the organization.
Performs employment functions in collaboration with Human Resources, including staffing, recruitment, performance management, professional development, and termination.
Coaches, inspires, and recognizes staff.
Creates opportunities for professional development.
Promotes participation in training initiatives and organizational activities, as well as adherence to external regulations and internal policies.
Fosters a culture of success in alignment with the organizational mission, vision, and values.
Essential Organizational Functions
Supports and operates in alignment with the organization’s core values.
Strives to meet work goals that contribute to departmental and organizational goals.
Adheres to organizational standards, policies and procedures, as well as compliance requirements.
Performs other duties as assigned.
Technical Knowledge, Skills and Abilities Required
Strong understanding of managed care and publicly-financed health care stewardship principles
Advanced knowledge of clinical workflows and electronic health record systems within primary care
Advanced knowledge of value based payment model theory, operations, and principles
Demonstrated knowledge of best practices that drive an environment of continuous improvement
Demonstrated leadership effectiveness and ability to design and implement constructive change
Highly effective written and verbal communication skills, as well as strong presentation skills
Ability to negotiate and execute complex contractual relationships to align with specific corporate initiatives, strategies, goals and objectives.
Thorough knowledge of principles and statistical methodologies for program assessment and evaluation
Extensive data analysis skills derived from formal statistical knowledge and training
Possess a high degree of initiative and motivation along with the ability to effectively collaborate and plan with departmental leadership and staff, and other stakeholders/customers
Highly effective strategic planning and resource management skills
Highly collaborative, cross-functional and systematic
High degree of diplomacy, credibility and persuasiveness to consistently cultivate effective working relationships; ability to effectively express ideas and gain acceptance
Physical Skills and Abilities Required
Lifting/Carrying up to 0 Pounds
Pushing/Pulling up to 0 Pounds
Pinching/Retrieving Small Objects
Reaching Above Shoulders
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
Cognitive and Other Skills and Abilities Required
Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.
Education and/or Experience
Minimum 12 years’ related experience, including 5 years’ experience in clinical and/or operational functions within a managed care or health care environment
Minimum 5 years’ experience managing people
Management experience in a managed care organization or practice setting
Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes
Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment
Veterans are strongly encouraged to apply.
Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.Position Description »