Job Summary:

KP-s vision is to be the leader in value-based care, improving health outcomes and increase access to affordable care through evidence-based medicine. This role will lead the design and implementation of value-based strategies (influence cross functional leaders, including Medical Group, Operational Shared Services, IT etc.) across all Kaiser Permanente Health Plan markets and ensure the organization is well positioned in a changing healthcare ecosystem. Currently KP has relationships with external providers with a combined spend of approximately 19B, and in the future we expect continued growth at about 6% / year. The role will be responsible for developing and executing the external provider strategy to deliver market leading outcomes and is accountable for value-based contracting, network development and management across all markets - including the development of advanced alternative payment models and programs. The role will be accountable for identifying and implementing initiatives to strengthen/develop partnerships with like-minded provider organizations to expand Kaiser Permanente-s addressable market while delivering comparable outcomes to our core integrated delivery system. The role monitors performance to ensure provider networks yield market leading outcomes for unit cost performance, total cost of care, cost trend and clinical outcomes. This role is a central member of the team charged with developing requisite systems and infrastructure for value-based solutions including digital experiences for consumers and providers, evidence-based interoperability, as well as triage access and navigation.

Essential Responsibilities:

• Serve as a strategic, highly visible leader representing Kaiser Permanente to advance value-based care and payment systems across the industry.

• Expand foundational capabilities to support complex value-based compensation models and network strategies.

• Lead the development, support negotiations and implementation of tiered and narrow network products and value-based contract arrangements.

• Direct advanced alternative payment models including development and rollout of new payment methodologies, implementation of programs to support improved provider quality and cost performance.

• Oversee cost reduction programs to improve the total cost of care.

• Develop and oversee programs to cultivate and maintain product relationships with key providers, networks and organized provider groups.

• Partner with company-wide leaders to develop and execute short and long-range plans, goals and objectives related to provider network strategy, contracting, provider satisfaction, quality, and cost.

• Ensure networks support goals regarding affordability, geographic coverage, marketability, and satisfaction.

• Collaborate with clinical leadership in the development of clinical and quality oversight of provider networks and support the spread of best practices between KP and provider network partners.

• Drive measured performance and reporting of Nationally developed guidelines for payment innovations in all KP regions.

  Basic Qualifications:

  Experience

• Minimum fifteen (15) years of broad health care and medical management leadership experience with at least ten (10) years healthcare payer experience.

  Education

• Bachelors degree in related field, OR four (4) years of experience in a directly related field.

• High School Diploma or General Education Development (GED) required.

  License, Certification, Registration

• N/A

  Additional Requirements:

• Expertise related to health insurance industry trends, reimbursement methods and evolving accountable care and payment models.

• Broad end-to-end experience with medical care management such as product design, provider contracting, utilization management, care management, quality and go-to-market strategies.

• Demonstrated success in contract negotiation and managing relationships with hospitals, provider groups and integrated delivery systems.

• Strong communication and facilitation skills with all levels of the organization and executive-level external partners, including the ability to resolve issues and build consensus among groups of diverse stakeholders.

• Deep business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making.

• Demonstrated competency related to creating and executing business strategies and driving results that spans different markets and/or within a large, complex organization and/or with external partners.

• Innovative thinker with ability to articulate a vision, manage complexity and lead change.

• Demonstrated ability to lead high performing diverse teams and manage and develop leaders.

• Ability to formulate plans with strategic execution.

• Expertise in conflict-resolution is essential.

• Possesses the following attributes:

• Self-directed

• Creative and strategic

• Curious

• Passionate about making provider networks works for the member

• Willing to take risks

  Preferred Qualifications:

• Master-s degree in business, Health Care Administration, Public Health, and/or MD preferred.

COMPANY: KAISER

TITLE: VP, Value Based Care Provider Enablement

LOCATION: Oakland, California

REQNUMBER: 1309458

External hires must pass a background check/drug screen. 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. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.