Health First
VP Managed Care
Health First, Rockledge, Florida, United States, 32955
DescriptionThe Vice President of Managed Care is responsible and accountable for providing Uncompromised Safety, Superior quality, Memorable Patient/Customer Experiences, and Financial Stewardship by creating, leading, and conducting all managed care activities for Health First. This position supports and furthers the organization's goals of growth, financial strength, and quality outcomes. The VP will partner with senior management in developing innovative payment relationships with third-party payors across the region, securing optimal reimbursement and protecting the interests of the system and physicians’ group in contract negotiations and the implementation and management of managed care contracts and relationships, essential to the Network’s long-term financial viability.
The Vice President of Managed Care will need to be aware of changes in the healthcare environment. The VP will use their knowledge and overall market acumen to lead change initiatives regarding managed care contracting opportunities and will play a leading role in creating innovative payment arrangements with third-party vendors, including the development of pay for performance, value-based purchasing, accountable care organizations (ACOs), bundled payments, and patient-centered medical homes.
PRIMARY ACCOUNTABILITIES
Manage all aspects of third-party contracting for the health network and physician members of the organization, including analysis/evaluation, negotiation, implementation, and administration.
Lead and manage the assessment and/or development of innovative payment mechanisms, including capitation, bundled payments, and global fees or value-based contracting.
Conceptualize a vision for the managed care department, including a structure for the organization, systems and processes, and both short and long-term goals. Ensure that the outlook for the managed care department supports Health First’s strategic plan and communicates the vision system-wide.
Lead and coordinate activities of staff in the analysis, negotiation, and management of existing managed care contracts, including maintaining various activity reports in support of financial reporting related to managed care contract performance.
Work closely with employed physician groups regarding managed care contracts, strategies for improving market share, financial performance of the contracts, and opportunities to collaborate and build relationships.
Work in tandem with Network leadership regarding contract pricing and managed care strategy in the market. Identify opportunities to improve financial and market share performance and play a lead role in addressing opportunities to improve profitability.
Develop and enhance relationships with external contacts such as the broker community, various healthcare trade associations, business coalitions, governmental agencies, and consultants. Represent Health First in meetings with other organizations, associations, providers, and payers regarding all aspects of managed care.
Coordinate with Decision Support and other system and hospital departments regarding the operation, utilization, and selection of managed care-related information systems.
Analyze contractual language for functional, financial, and ethical appropriateness. Determine compliance with established legal requirements and negotiate contract language in a manner consistent with the authority delegated to this position by Health First legal counsel.
Coordinate implementation of managed care contracts with Patient Financial Services, Patient Access, Case Management, and other departments along the continuum. Develop and maintain systems and procedures to disseminate pertinent contract information in a timely manner to appropriate Network personnel.
Qualifications
MINIMUM QUALIFICATIONS
Education: Bachelor’s degree is required, preferably in business or a healthcare-related field from an accredited college or university.
Licensure: None
Certification: None
Work Experience: Ten plus years’ experience with progressive responsibility in healthcare management, complex managed care contract negotiating, and PPO/HMO and insurance principles.
Work Experience in lieu of Education: None
Knowledge/Skills/Abilities:
Solid understanding of managed care contracts.
Skilled negotiator with excellent quantitative, oral, and written communication skills tempered through complex managed healthcare contract negotiations.
Comprehensive leadership and decision-making skills with a demonstrated aptitude for analytical thinking and an ability to report findings accurately.
Ability to work effectively with all levels of management and physicians.
Proven critical thinking skills with an ability to draw upon a current understanding of the reforming healthcare environment to assess the impact on provider contracting of relevant topics and programs such as the Affordable Care Act of 2010, Accountable Care Organizations, bundled payments, and patient-centered medical homes.
Proven ability to build strong interpersonal relationships within a large, complex healthcare organization, including staff, peers, and executive leadership.
Proven experience in building appropriate relationships within large healthcare payor organizations.
Job:
Corporate ServicesOrganization:
Health First Shared Svcs IncPrimary Location:
United States- Florida - Brevard County- RockledgeSchedule:
Full-timeShift Times:
8:00 am - 5:00 pmJob Level:
Vice President
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The Vice President of Managed Care will need to be aware of changes in the healthcare environment. The VP will use their knowledge and overall market acumen to lead change initiatives regarding managed care contracting opportunities and will play a leading role in creating innovative payment arrangements with third-party vendors, including the development of pay for performance, value-based purchasing, accountable care organizations (ACOs), bundled payments, and patient-centered medical homes.
PRIMARY ACCOUNTABILITIES
Manage all aspects of third-party contracting for the health network and physician members of the organization, including analysis/evaluation, negotiation, implementation, and administration.
Lead and manage the assessment and/or development of innovative payment mechanisms, including capitation, bundled payments, and global fees or value-based contracting.
Conceptualize a vision for the managed care department, including a structure for the organization, systems and processes, and both short and long-term goals. Ensure that the outlook for the managed care department supports Health First’s strategic plan and communicates the vision system-wide.
Lead and coordinate activities of staff in the analysis, negotiation, and management of existing managed care contracts, including maintaining various activity reports in support of financial reporting related to managed care contract performance.
Work closely with employed physician groups regarding managed care contracts, strategies for improving market share, financial performance of the contracts, and opportunities to collaborate and build relationships.
Work in tandem with Network leadership regarding contract pricing and managed care strategy in the market. Identify opportunities to improve financial and market share performance and play a lead role in addressing opportunities to improve profitability.
Develop and enhance relationships with external contacts such as the broker community, various healthcare trade associations, business coalitions, governmental agencies, and consultants. Represent Health First in meetings with other organizations, associations, providers, and payers regarding all aspects of managed care.
Coordinate with Decision Support and other system and hospital departments regarding the operation, utilization, and selection of managed care-related information systems.
Analyze contractual language for functional, financial, and ethical appropriateness. Determine compliance with established legal requirements and negotiate contract language in a manner consistent with the authority delegated to this position by Health First legal counsel.
Coordinate implementation of managed care contracts with Patient Financial Services, Patient Access, Case Management, and other departments along the continuum. Develop and maintain systems and procedures to disseminate pertinent contract information in a timely manner to appropriate Network personnel.
Qualifications
MINIMUM QUALIFICATIONS
Education: Bachelor’s degree is required, preferably in business or a healthcare-related field from an accredited college or university.
Licensure: None
Certification: None
Work Experience: Ten plus years’ experience with progressive responsibility in healthcare management, complex managed care contract negotiating, and PPO/HMO and insurance principles.
Work Experience in lieu of Education: None
Knowledge/Skills/Abilities:
Solid understanding of managed care contracts.
Skilled negotiator with excellent quantitative, oral, and written communication skills tempered through complex managed healthcare contract negotiations.
Comprehensive leadership and decision-making skills with a demonstrated aptitude for analytical thinking and an ability to report findings accurately.
Ability to work effectively with all levels of management and physicians.
Proven critical thinking skills with an ability to draw upon a current understanding of the reforming healthcare environment to assess the impact on provider contracting of relevant topics and programs such as the Affordable Care Act of 2010, Accountable Care Organizations, bundled payments, and patient-centered medical homes.
Proven ability to build strong interpersonal relationships within a large, complex healthcare organization, including staff, peers, and executive leadership.
Proven experience in building appropriate relationships within large healthcare payor organizations.
Job:
Corporate ServicesOrganization:
Health First Shared Svcs IncPrimary Location:
United States- Florida - Brevard County- RockledgeSchedule:
Full-timeShift Times:
8:00 am - 5:00 pmJob Level:
Vice President
#J-18808-Ljbffr