Head of Network Development - UK, Remote
As the largest health insurance payer in the United States, and a leading International Private Medical Insurer, managing the healthcare spend across a provider network of hospitals, physicians and healthcare partners is critical to our success. The successful candidate will lead the global provider network development to optimize and expand coverage and quality for United Healthcare Global Solution’s (UHCGS) expat insurance and assistance network, its clients and its customers. This role will manage provider engagement, network development strategy, contract negotiation, contract implementation, network trend management, sales support, and network configuration pricing support yielding a geographically competitive, broad access and stable network. This role will manage a team of diverse network managers, and collaborate closely with Network Operations, Strategic Partnerships, and Health Intelligence teams within the broader network team. The role holder will work cross functionally across multiple lines of business to deliver best in class worldwide network solutions This role reports to VP, Global Network Management and Strategic Partnerships.
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Develop global provider network and manage strategic provider relationships, including network planning, provider issues resolution, direct contracting, and TPA implementation and governance, while support business growth and sales strategy. Lead internal network managers and influence market key providers to achieve company targets and goals.
The role holder is expected to be able to drive customer and financial value through the development of the strategic solutions to manage access to high quality, cost effective, customer focused healthcare.
The Head of Network Development develops the provider network strategy (physicians, hospitals, ancillary groups and facilities, healthcare partners etc.) yielding a geographically competitive, broad access, stable network, that achieves core objectives for UHCGS. Included in these duties are remote or in-person contracting, negotiating contracts in compliance with company regulations, educating providers on operational and claims procedures, and generally advancing the good reputation of UHCGS within international provider community. Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of providers and provider specialties. Other key responsibilities include:
- Lead regional network managers in meeting goals relating to network initiatives and provider engagement
- Coordinate, triage, and resolve escalated provider issue within and across regions
- Identify and lead process changes to improve provider services and in turn improve client and member experiences
- Engage with broader enterprise network solutions to ensure optimal access, value for money and service experience for UHCGS
- Drive value for money with Fraud, Waste and Abuse initiatives and controls
- Validate quality of care across international healthcare landscapes
- Implement contractual frameworks that support UHCGS Duty of Care to customers and clients and enable commercial frameworks for value and service
- Manage provider database content to maintain data integrity and solutions to support internal and external consumer requirements
- Responsible for various Third Party Administration (TPA) contracting, implementation, operations, and performance management.
- Gather market competitive intelligence and organize information on global health care delivery systems
- Network vendor relationship management
- Maintain documentation of provider interactions, records, questionnaires, contracts, and tax forms, etc.
- Support sales efforts by researching/gathering/preparing responses to RFPs developing presentation, and/or participating in client meetings. Possibly accompany sales team on sales calls to client location
- Develop provider engagement plan, and conduct provider education on providers’ premises where hospital/provider staff will be trained on procedures for working with UHCGS
- Represent United Healthcare Global Solutions at industry conferences and advance the United Healthcare brand in the company of foreign providers, accreditation bodies, national health government, etc.
- Data analysis to drive network strategy and influence pricing practices
- Data reporting to communicate activities and delivery to a broad internal and external audience
Analyze current network (performance) against market expectations for network development plan
- Demonstrate understanding of expat insurance products, plans and benefit management
- Analyze product, markets, and provider utilization and contract performance
- Demonstrate understanding of contract language in order to assess financial and operational impact and legal implication of requested contract changes
- Demonstrate understanding of competitor landscape within market (e.g. rates; market share; products; provider networks; market intelligence; GeoAccess)
- Seek information from relevant sources (e.g. publication; government agencies; providers; provider trade associations) to understand and communicate market intelligence information
Develop/Negotiate/Support terms of agreement with providers
- Balance financial and operational impact of contracts to providers, members, UHCGS, and different customer groups when developing and/or negotiating contract terms
- Weigh financial and operational information to evaluate provider participation
- Demonstrate understanding of contract policies to ensure compliance and consistent contracting across regions
- Evaluate market rates and provider performance (e.g., billing patterns; quality and effectiveness) to establish negotiation strategies
Manage provider relationships
- Educate providers on the organization’s processes, policies, and procedures in order to ensure provider compliance and ease of administration
- Identify and gather information regarding provider issues in order to develop and/or implement strategy to resolve matter, keep stakeholders informed of progress, or escalate issues to appropriate internal business partner
- Monitor and/or oversee network performance to identify opportunities to improve performance and/or provider relationship
- Develop a comprehensive and globally/culturally appropriate provider engagement and communication plan for global network expansion and optimization
Develop/Implement/Execute/Support market strategies
- Implement local, regional, and/or global initiatives and directives (e.g., ICD10; medical necessity language, DRG contracting) through contracting strategies and communication efforts
- Identify and share best practices (e.g., payment methodologies; negotiation tactics) with regional colleagues
- Modify and/or develop new payment methodologies in order to execute market strategies
- Present and discuss industry and market trends with internal and/or external groups (e.g., customer groups; brokers; professional associations; providers) in order to facilitate market strategy development and implementation
- Develop and/or implement contracting strategies to support new benefits designs and plans
Deliver cross functional business projects:
- Build and manage project plans and delivery across cross functional/cross market requirements
- Develop financial business cases to demonstrate cost benefit analysis, return on investment and implement measures to demonstrate delivery and value
- Ensure compliance to multi jurisdictions regulatory requirements
Develop and maintain strategic third-party relationships
- Undertake detailed assessment of business needs
- Research and recommend options and solutions to meet business needs
- Develop and deliver onboarding materials and processes to meet internal and external requirements to demonstrate due diligence in partner selection and engagement
- Build processes, procedures, governance controls, measures and reporting to enable interface and delivery of services with strategic partners
- Contract with external partners
- Negotiate service and commercial terms that ensure best results for UHCG
Qualifications and Skills
- Degree or MBA in business, healthcare, or related field
- Significant experience within healthcare sector, global experience required
- Significant experience in international provider network management, international private medical insurance and/or international assistance industry
- Strong commercial knowledge of international healthcare landscapes
- Proven people leadership experience
- Proven track record of achieving targets with a consistent high level of quality and timely delivery
- Project management experience
- Ability to detail processes and practices and ensure adherence to deliver against commercial and compliance requirements
- Established reputation within global provider communities preferred
- Strong interpersonal skills, establishing rapport and working well with others in matrix organization
- Sales orientation, meaning possesses natural reflexes to promote, persuade, and negotiate
- National and international required, may include developing countries
- Excellent presentation skills
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