Miles Ueoka
Tigard,OR
Summary
Performance-driven Leader with years of experience aligning system goals and objectives with solid business strategy and execution excellence. Passionate about highlighting and elevating OHSU's value to patients, providers and payors through Managed Care and Payor Strategy.
Overview
29
29
years of professional experience
Work History
Director, Value Based Performance
OHSU
10.2019 - Current
- Led development of data, analysis and insights to support Value Based contracting initiatives of the OHSU Office of Payor Strategy.
- Cultivated strategic relationships with key payors to drive sustainable growth in value based arrangements.
- Drove health plan partners to consider benefit/network design as well as price in the value equation.
- Enriched complex and challenging negotiations with data driven models and market insights.
- Provided financial projections and settlement estimates to Health Care CFO and VP of Hospital Finance to ensure accurate budget accruals.
- Interfaced with Contract Modeling team to ensure models provided accurate assessment of value based opportunities.
- Represented OHSU Health Services in both internal and external committees and workgroups.
- Provided the analytic voice and perspective to and for Payor Strategy leadership in both internal and external settings.
- Participant in Payor Strategy Leadership team responsible for developing Value Based strategy and execution plan.
Manger, Value Based Performance
Adventist Health System
02.2019 - 10.2019
- Developed proformas to assess risk-based opportunities with Adventist Health, OHSU and THA's Health Plan partners.
- Collaborated with cross functional team to optimize Value Based performance.
- Developed and maintained budgeting tool and process for Managed Care Contracting.
- Developed "What If" models to aid complex negotiations with key payor partners.
- Participated in various leadership, financial, cost and quality and growth workstreams with Health Plan partners.
Managed Care Strategic Analytics
Adventist Health System
06.2018 - 06.2019
- Developed financial models to support Managed Care negotiations with Health Plans.
- Created tools to evaluate contracts for financial performance and reimbursement efficiency.
- Integrated third-party analytics solutions into ongoing projects.
- Developed and maintained system wide Value Based contract reporting tool.
Interim Sr. Director Managed Care
Adventist Health System
10.2017 - 06.2018
- Negotiated, maintained and evaluated Adventist Health Facility contracts for the Pacific Northwest Region.
- Supported advancement of corporate initiatives by negotiating contracts with payors who were strategically aligned with Adventist Health.
Sr. Financial Analyst
Adventist Health
06.2012 - 11.2014
- Developed analytical processes and tools that aided strategic decisions in markets across the Adventist Health System.
- Collaborated with Adventist Health Payor and Network Strategy functional areas to ensure smart growth and improved margins.
Market Surveillance Manager
Oregon Insurance Division
09.2011 - 02.2012
- Developed and maintained processes, systems, and communication networks for identifying, assessing and prioritizing market conduct problems and issues.
- Managed complex investigations and enforcement projects.
- Oversaw preparation and maintenance of supporting documentation for all analysis and market conduct activities.
- Assessed effectiveness of insurance markets and monitored the individual companies comprising the market.
Director of Business Intelligence
Cambia Health Solutions- Regence
01.2007 - 06.2011
- Assessed market performance of four Plans relative to competition, customer satisfaction, broker/agent perceptions and performance to the corporate enrollment forecast.
- Participated as part of corporate planning team in the design and deployment of annual planning agendas and development of strategic and annual planning documents as it relates to market dynamics and corporate performance.
- Developed target pricing frame work for new products and product enhancements.
- Directed assessment of growth and profitability trends by segment for strategy development in partnership with actuarial, underwriting and sales.
- Performed ongoing customer/market research and demographic profiling to identify unmet market needs or unrecognized market opportunities.
- Provided business intelligence expertise to senior management team through development of reports or presentations.
- Directed and oversaw product and price positioning analysis to support product development, consumer marketing, sales, actuarial and underwriting to position the company to "win" in the market place.
- Participant in Blue Cross Blue Shield Association 2020 strategic plan.
Asst. Dir. of Mkt. Positioning, Sizing and Segment
Cambia Health Solutions- Regence
12.2005 - 01.2007
Manager, Business Intelligence
Cambia Health Solutions- Regence
06.2004 - 12.2005
Actuarial Analyst
Cambia Health Solutions- Regence
10.2002 - 06.2004
Underwriter, Small Group
Regence Blue Cross Blue Shield Of OR
08.2001 - 10.2002
Business Analyst
Decision Research Corporation
05.1999 - 02.2000
Underwriting Manager
HMAA
06.1997 - 05.1999
Underwriting Manager
University Health Alliance
03.1996 - 04.1997
Underwriting Actuarial Analyst
Pacific Heritage Assurance
09.1994 - 12.1995
Education
Bachelor of Science - Public Policy And Administration
Western Oregon University
Monmouth, OR06.1994
Skills
- Excellent analytic and negotiation skills
- Professional understanding of healthcare finance and funding for Health Plans and Providers for all lines of business
- Demonstrated ability to make data-driven decisions and recommendations
- Health System strategy development
- Ability to navigate complex and matrixed organizations
- Recognized and respected Health Care thought leader
- Well established business relationships with Health Plan executives
- Proficient in contract modeling and structures to facilitate on-time data and analysis
- Expert in Health Care trends and market analysis
Timeline
Director, Value Based Performance
OHSU
10.2019 - Current
Manger, Value Based Performance
Adventist Health System
02.2019 - 10.2019
Managed Care Strategic Analytics
Adventist Health System
06.2018 - 06.2019
Interim Sr. Director Managed Care
Adventist Health System
10.2017 - 06.2018
Sr. Financial Analyst
Adventist Health
06.2012 - 11.2014
Market Surveillance Manager
Oregon Insurance Division
09.2011 - 02.2012
Director of Business Intelligence
Cambia Health Solutions- Regence
01.2007 - 06.2011
Asst. Dir. of Mkt. Positioning, Sizing and Segment
Cambia Health Solutions- Regence
12.2005 - 01.2007
Manager, Business Intelligence
Cambia Health Solutions- Regence
06.2004 - 12.2005
Actuarial Analyst
Cambia Health Solutions- Regence
10.2002 - 06.2004
Underwriter, Small Group
Regence Blue Cross Blue Shield Of OR
08.2001 - 10.2002
Business Analyst
Decision Research Corporation
05.1999 - 02.2000
Underwriting Manager
HMAA
06.1997 - 05.1999
Underwriting Manager
University Health Alliance
03.1996 - 04.1997
Underwriting Actuarial Analyst
Pacific Heritage Assurance
09.1994 - 12.1995
Bachelor of Science - Public Policy And Administration
Western Oregon University
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