EVP, Payer Strategy OptumRX, Genoa Healthcare
Opportunities with Genoa Healthcare. A career with Genoa Healthcare means you're part of a collaborative effort to serve behavioral health and addiction treatment communities. We do more than just provide medicine: we change lives for the better. People with serious mental or chronic illness – and those who care for them – have moving stories, and at Genoa we become their voice, their partner. Working as part of a coordinated care team, we partner with community-based providers and others to ensure that people with complex health conditions get the right medications and are able to follow their treatment plans. Our personalized services – in-clinic pharmacies, telepsychiatry and medication management – are leading the way to a new level of care.
We recently joined OptumRx, a pharmacy care services company that is part of Optum and UnitedHealth Group’s family of businesses. We are part of a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. Take a closer look to learn why a career with Genoa Healthcare might be the path to discovering your life's best work.SM
Genoa knows its success is due to the talented and committed individuals who bring constant energy and drive to the company’s leadership in the behavioral health pharmacy industry. Genoa focuses on building people, careers, and teams who in turn build its world-class company, and the company seeks an Executive Vice President, Payer Strategy to bring strategic and creative direction to a new era of growth and to build deep-seated relationships within the payer industry.
Reporting to the CEO of Genoa Healthcare, the EVP of Payer Strategy will be the leader in transforming direct payer and health plan opportunities to grow the Genoa business model and successfully expand the reach of Genoa’s integrated pharmacy care model to complex populations including those with Severe and Persistent Mental Illness. The EVP will also manage our procurement strategy as well as networking contracting efforts to executive against the defined strategies. This dynamic and inspirational member of the executive team will be the company’s brand champion across the health care system and procurement channel infrastructure.
Key responsibilities of this position include:
- Lead cross-functional strategic planning for payer / value programs include 3-5 year planning cycle and analysis of new business opportunities with strong tie to Finance and Operations functions.
- Manage business development initiatives to grow payer based/referral and valued based business. Lead account management activities. Deliver against forecasted targets. Oversee incentive programming, quota forecasting and budgeting process.
- Establish and own relationships with payer communities including Managed Medicaid Plans, MAPD and SNP Plans, Managed Behavioral Health organizations, Accountable Care Organizations and other Risk bearing Medical groups.
- Manage pharmacy and medical claims contracting, network management and performance measurement, pharmacy licensing and payer audit activities for all lines of business across all states.
- Responsible for pharmacy procurement operations & strategy. Partnering with Optum Rx purchasing framework to deliver value for business unit.
- Develop and lead overall payer contracting strategy and execution including negotiations, contract management, and profitability targets.
- Lead the strategic development of new pharmacy care programs and value based initiatives that demonstrate value of integrated pharmacy care model inclusive of coordinating program initiatives across Optum.
- Oversee product design and implementation for all direct healthplan programs including the execution of multipayer business development plans.
- Lead RFP content development and support enterprise RFP opportunities for business expansion and new business development for enterprise.
- Educate payers and develop the company’s brand and identity to support the mission of a growing, customer-focused company.
- Keep abreast of state and federal government legislation as well as market dynamics to anticipate industry and payer trends.
- Overall accountability for Total Cost of Care analytics in coordination with health plan and Behavioral health partners to ensure Genoa pharmacy care model value is effectively measured across all total cost of care and affordability initiatives.
- Partner with field operations teams in the design, implementation and execution of new and expanding direct health plan and value based programs
- Participate with other senior leaders to establish corporate strategic plans and objectives, identifying strategic needs and prioritizing areas of focus.
- 10-15+ years total professional experience, with significant experience working for a large multi-state healthcare organization.
- Demonstrated experience with negotiating direct chain agreements with PBMs and other payers.
- Demonstrated experience in the design and implementation of innovative care models and products to improve overall quality and affordability specifically to support better care for complex populations within Medicaid and Medicare programs.
- Experience developing relationships within the healthcare industry including, PBMs, health plans, provider groups and Managed care behavioral health organizations; network of relationships at the highest level that can be leveraged.
- Demonstrated financial acumen specific to FFS and value based reimbursement models across pharmacy, medical, and behavioral health services.
- Extensive knowledge of Medicare Part D, MAPD, SNPs, and Managed Medicaid reimbursement across Medical, behavioral and pharmacy managed care programs.
- Experience negotiating and interfacing with payers within risk based reimbursement models.
- A change agent, transformational leader and game changer within an organization.
- Strong knowledge of managed care benefit strategies and trends.
- Highly developed relationship-building skills to foster effective working relationships across Genoa, Optum and the UHG enterprise.
- Undergraduate degree required.
- Advanced degree, Pharm.D. or MBA is highly desirable.
Desired Competencies, Skills and Attributes
The candidate will have achieved his/her past success thorough the demonstration of several critical behavioral competencies.
Results Orientation – He/She has demonstrated the ability to achieve functional and company results that surpass expectations across multiple periods of time within one organization. This executive will have an innate thirst to drive for results that over-index against key performance benchmarks within the industry. The candidate will have imported or created new solutions, business opportunities, or processes that have a measurable impact to firm value and market share.
Strategic Orientation to transform the healthcare industry – He/She will have the intellectual capacity to discern complex perspectives within competing or new markets to create a compelling, coherent strategy that positions Genoa to win beyond its short-term goals. They will have designed and implemented innovative strategies, perhaps beyond their own area of responsibility that moved a company into broader and/or an entrenched leadership role within their industry.
Collaboration – He/She understands how to effectively influence and collaborate horizontally and vertically to achieve consensus and alignment that supports the actions and goals of the management team. The executive will have demonstrated how they build trust vertically and horizontally and have used influencing styles (direct and indirect) to create successful solutions that were broadly adopted.
- The intelligence, motivation, and passion to build a world-class company and deliver value to shareholders and customers.
- Passion and demonstrated ability to develop new relationships across the healthcare industry
- Sales mindset and sense of urgency
- The ability to be a strategist and catalyst for change.
- Exceptional ability for analytical and strategic thinking.
- Ability to roll up sleeves and contribute directly.
- A “partner” mindset, facilitating close work with the management team in developing strategy.
- Strong entrepreneurial drive, high energy, a “self-starter” attitude, the ability to set and meet aggressive goals, and the drive to succeed both personally and professionally.
- A commanding presence, excellent written and oral communication skills, and superior presentation abilities to be a credible internal and external spokesperson.
- The ability to communicate a vision and lead others to execute it.
- The ability to hold others accountable and to proactively address and resolve conflict.
- The ability to create a culture of shared values in which employees work cooperatively toward common and mutually recognized objectives.
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.