VP of Operations

UHS•Reno, NV

About The Position

The Vice President of Operations leads and manages Prominence Health’s Operations in alignment with its strategic goals. The role supports the organization’s financial performance goals and its work to build capacity for UHS’s clinical integration strategy. The incumbent has direct responsibility for Enrollment, Claims, Configuration, and Customer Service, and oversees current and future lines of business, including Medicare Advantage, Commercial, and ASO/Self-Funded. As a member of Prominence Health’s senior leadership team, the VP is jointly accountable for financial, quality, and service goals and represents Prominence in UHS workgroups focused on clinical integration and population management. Prominence Health is a value-based care organization that connects affiliated health systems and independent providers. It works across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships to improve health outcomes, control costs, and enhance the patient and member experience. Founded in 1993, it was acquired by a UHS subsidiary in 2014.

Requirements

Bachelor’s degree in Business or a related health care field, and a Master’s degree in Public Health or an MBA.
At least eight years of Operations management or consulting experience, including at least three years of managed care experience.
Experience optimizing the commercial revenue cycle from rate development through billing and collection.
Experience optimizing benefit administration from benefit design through provider contracts and claims.
Experience with provider networks, including reimbursement models such as P4P and capitation, contracting, and their operational impact.
Experience with self-funded groups, including benefit design, reinsurance contracts, and client reports.
Experience with a multi-state Medicare Advantage program.
Strategic and tactical experience working with CMS.
Experience with delegated entities and strong coordination capabilities to direct and supervise interactions between Prominence functional areas and delegated entities.
Ability to build in-house infrastructure to bring outsourced functions in-house.
Experience collaborating with Compliance.
Detailed understanding of the bid submission process and the risk score collection and documentation process.
Detailed understanding of the Star rating process and demonstrated ability to move a plan toward a 5-star rating.
Strong communication, influencing, presentation, and relationship-building skills.
Proficiency in Microsoft Office Suite.
Ability to take concepts from initial development through implementation and administration.
Ability to communicate effectively with external and internal stakeholders.
Demonstrated ability to build a highly functioning team and mentor direct reports.
Experience with Commercial, Self-Funded, and Medicare Advantage network requirements.
Ability to foster collaboration among divergent stakeholders and credibility with key stakeholders based on past accomplishments.
Experience negotiating complex provider reimbursement arrangements and third-party contracts.
Ability to manage outsourced vendor relationships in compliance with NCQA and CMS delegated entity rules.
Comfort managing interfaces with Prominence functional areas and third-party partners.
Ability to guide an organization through cultural change focused on individual accountability and performance.
Solid understanding of health plan financial drivers and a service-excellence orientation toward internal and external stakeholders.

Responsibilities

Lead and manage Prominence Health’s Operations in alignment with the organization’s strategic goals.
Support achievement of financial performance goals and build capacity for UHS’s clinical integration strategy.
Take direct responsibility for Enrollment, Claims, Configuration, and Customer Service.
Oversee current and future lines of business, including Medicare Advantage, Commercial, and ASO/Self-Funded.
Share accountability with the senior leadership team for financial, quality, and service goals.
Represent Prominence in UHS workgroups focused on clinical integration and population management.