Sutter Health Vice President (VP), Network Contracting, Health Plan Products (HPP) in Sacramento, California

Position Overview:

JOB SUMMARY

Vice President (VP), Network Contracting, Health Plan Products (HPP) serves as Sutter Health’s primary downstream network strategist and manager, ensuring that Sutter maintains an innovative, financially-sustainable downstream network and relationships to serve all populations in a way consistent with the mission of Sutter Health. Responsible for the strategic and tactical direction of activities for downstream network contracting across all entities within Sutter Health, including Sutter Health Operating Units, Sutter Health Plus, Sutter Select Network, and the Sutter Medical Network.

This position is responsible for leading downstream network contracting activities that support execution of Sutter’s product portfolio, developing and maintaining a contract performance analytical function, developing and maintaining a provider contract data management function, developing and maintaining strong business relationships with stakeholders involved in contract activities, and directing contracting operations functions and coordinating standardization across contracts to support Sutter’s business objectives.

The Vice President (VP), Network Contracting, Health Plan Products (HPP) must work closely with the Office of General Counsel and other supporting parties to ensure all communications and contracts related to risk arrangements are compliant with all current regulations and governing law; may be recognized as a system expert related to risk arrangements and contracts.

Qualifications:

MINIMUM POSITION REQUIREMENTS

EDUCATION:

Bachelor’s required (or equivalent); Master’s Desired.

EXPERIENCE:

  • Extensive experience working as a senior leader in a network management-related role handling complex network providers with accountability for business results, as typically acquired during 5-10 years working in a similar position

  • Comprehensive experience working in the health care industry is required

  • Proven experience in managed care contracting, network management, development, or provider relations

  • Previous experience in Commercial, Medicaid, and Medicare contracting including negotiating hospital, large physician groups, and ancillary service agreements

  • Previous experience in leased network arrangements and other contractual relationships with other purchased healthcare services in a vendor capacity

  • Proven management experience including responsibilities for hiring, training, assigning work, and managing the performance of staff

  • Demonstrated experience in the development of product pricing and utilizing financial modeling in making rate decisions

  • Demonstrated experience overseeing data governance strategy and data stewardship activities of business data

  • Seasoned experience dealing directly with payers, providers, and intermediaries in a health care industry environment, with an emphasis on negotiations, setting network strategies, and strong reimbursement competencies

KNOWLEDGE:

  • Demonstrated knowledge of managed care network management methodologies

  • Expert level knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.

  • Thorough knowledge of policies, standards, and government laws and regulations regarding contract negotiations

  • In-depth knowledge of financial strategies used to ensure goals are met

  • Working knowledge of reporting tools and methodologies used to track progress

  • Extensive knowledge of fee negotiations, reimbursement, and contract language review process and methodologies

  • Demonstrated knowledge of hospital and medical claims adjudication process, medical billing and coding terminology, and Medicare and industry billing policies and procedures

  • Understanding of, and experience with, Lean or other process improvement philosophies and methodologies desired

SKILLS:

  • Proficient Microsoft Word, Excel, and Power Point computer skills

  • Demonstrated leadership, teamwork, prioritization and public relations skills

  • Strong customer and provider relations skills

  • Excellent verbal and written communication skills with the proven ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as the ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards

  • Excellent organizational skills, with proven attention to detail, and strong interpersonal and team building skills

  • Demonstrated success in contract negotiations both as a strong advocate for Sutter Health, but also in a collaborative manner that promotes effective provider/payer relationships that mutually promote member, patient, and client interests

Organization: Sutter Health System Office

Employee Status: Regular

Employee Referral Bonus: No

Benefits: Yes

Position Status: Exempt

Union: No

Job Shift: Day

Shift Hours: 8 Hour Shift

Days of the Week Scheduled: Monday-Friday

Weekend Requirements: None

Schedule: Full Time

Hrs Per 2wk Pay Period: 80

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.