Vice President - Managed Care - FT - Days - MHS

Memorial Healthcare

8d•Onsite

About The Position

Corporate-level leader responsible for executing enterprise-wide strategic and tactical initiatives for complex negotiations with major national and regional payors on behalf of the health system's acute care, ancillary and professional providers. Manages execution and communication of contracting initiatives for integrated delivery system and clinically integrated network to drive positive financial trend and to achieve an appropriate market price point for over two billion dollars in contract revenue. Responsible for securing negotiations of all contractual provisions, evaluating and implementing appropriate financial reimbursement models and supporting operations by collaborating with clinical and administrative leadership to enhance revenue and address payer imposed challenges. Creates, guides and implements strategic and tactical initiatives to achieve organization and department goals.

Requirements

Bachelors (Required)
Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision.
Must be able to work in a stressful environment and take appropriate action.
Must be able to manage team towards achievement of strategic goals.
Strong technical, financial and negotiation skills.
Extensive managed care insurance and hospital industry knowledge.
Must be able to manage staff towards achievement of strategic goals.
Must have working knowledge of value based arrangements and financial risk arrangements.
Ten (10) years' progressive leadership experience in managed care required.
Bachelor's degree in Business Administration, Finance, Accounting , or in a job related field

Nice To Haves

Payer and provider experience preferred.

Responsibilities

Develops and leads strategy to preserve and enhance net revenues. Assures financial viability of contracts by leading financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution.
Develops, leads and executes strategies to protect and build market share using industry and utilization trends to strategically allocate revenue within plan contracts accordingly.
Participates in health plan litigation and development of related strategies, including communications with legal counsels, depositions, discovery and testifying on contract language.
Leads, executes and monitors managed care contracting strategies for complex legal, financial and operational contract language negotiations to drive a positive financial trend and achieve an appropriate market price point for all service lines in Memorial Healthcare System's (MHS) hospitals, Atlantic Coast Health Network (clinically integrated network), Memorial Health Network (clinically integrated network), MHS employed physicians, transplant programs (including subcontracting hospital-based groups), and ancillary services (ambulatory surgical centers, skilled nursing facility, rehabilitation facility, home health, home infusion, urgent care centers, sleep labs and other components) of the clinically integrated healthcare delivery system, and its jointly-owned or joint-ventured entities for fee-for-service and value based agreements (capitation, bundled payments, pay for performance, shared savings, shared risk and full risk agreements).
Directs and monitors financial performance of negotiations with major national and regional payors to ensure financial viability of contractual arrangements, achievement of goals, quality metrics and cost savings.
Monitors and researches insurance industry activities, healthcare reform, payer strategies, emerging market demands, and legislative considerations and changes to the managed care industry to devise and achieve a competitive position.
Leads and directs the strategic development and implementation of new product lines and alternative payment methods. Monitors the performance for expected results and adjusts strategies as needed.
Leads and monitors operational issues from Managed Care Revenue Optimization, Accounts Receivable Management, or Joint Operations for solution or potential dispute resolution.
Advises and supports optimal operational performance by collaborating with other departments and facility leadership impacted by payer organizations polices for authorization, denials, discharge planning, pharmaceutical programs, etc. Communicates information and coordinates with leadership to resolve issues.
Initiates, develops and presents managed care financial presentations for department and executive leadership. Communicates managed care strategy and initiatives throughout with leadership to ensure a cohesive application of strategy execution.
Directs and monitors department operations, activities, resources to meet budget and goals.
Leads, directs, and guides staff in deployment and execution of initiatives, goals and plans. Plans and monitors activities of staff and/or team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching and disciplinary actions, as applicable.