Job Description

Enterprise Vice President, Managed Care (US-Remote) FEATURED

Business Office · Managed Care
Plantation, FL
Finance/Insurance/Reimbursement
Full Time, Days
Weekly Schedule: Monday - Friday8:00am - 5:00pm
Bilingual: None
Bilingual Type: N/A
Posted 08/04/2022
Req # 9385

Enterprise Vice President - Managed Care

Under direction of the Chief Operating Officer the Vice President of Managed Care works in collaboration with Leadership and the management of all departments to optimize enterprise revenue through strong payor partnerships focusing on value-based care contract progression and fee for service rate progression as Pediatric Associates grows as the largest general pediatric value based care enterprise in the US. 

This Executive will strategically evaluate, modify, and develop best practice business processes while enhancing practice profitability and improving daily operations. The VP of Managed Care is responsible for direct revenue contract management including negotiation, analysis, interpretation, implementation, maintenance of the contract’s performance, and payer relations.

This leader will also lead development and execution of Value Based Care contract model and Fee for Service rate progression initiatives. The position is responsible for coordination and communication between managed care and other key stakeholder departments and Leadership. Models appropriate behavior as exemplified in Pediatric Associates Mission, Vision and Values and Loving Care Model of Care.

Location:

This role can be based anywhere in the United States, requiring travel as needed for client, leadership, and related in-person meetings.

 

ESSENTIAL FUNCTIONS OF THE JOB:

  • Leadership over the Enterprise Managed Care function, with direct leadership reporting teammates.
  • Defines strategy, plan and execution of payment models for VBC and FFS payor relationships.
  • Manages business alignment and scaling actions related to existing Claim and Utilization and Care management systems.
  • Establishes effective working relationships with executives and key business partners to collaboratively develop product strategies and creative solutions to business challenges
  • Defines programs, investment plans, business cases and projects
  • Applies technology best practices to drive change agenda to innovate across the enterprise
  • Provides leadership and accountability for the performance of managers and/or senior level professional staff
  • Develops (and adheres to) annual budgets and staffing plans
  • Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff.
  • Work most often impacts a large business unit, or multiple markets/sites.
  • Development of new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations.
  • Evaluates, negotiates, and secures financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations. Develops and supports managed care strategies and initiatives for Pediatric Associates to adapt to ongoing healthcare payment reforms and evolving payment methodologies.
  • Defines contract negotiation objectives in coordination with the Executive and Senior Leadership team and manage and support the maintenance of a detailed utilization database.
  • Monitors and plan for contract renewals, budget increases, and ensure that all renewals are completed. Works with the CFO’s for budgeting increases annually.
  • Serves as a resource for information about contract terms, managed care projects, payer processes, revenue cycle inquiries, and to facilitate the resolution of complex issues that arise.
  • Responsible for communications with third party payers regarding updates to the health system including changes in locations, additions, or other material system changes that impact payer contracts and reimbursement.
  • Coordinate preparation and completion of due diligence process for new entity acquisitions. Prepare documents for payers reporting changes in facilities or physician group information.
  • Manages all components of the contract negotiation process for directly negotiated contracts.
  • Identifies and implements contracting opportunities for revenue improvement and administrative efficiency, and ensure that contract renewals are modeled for financial impact.
  • Identifies opportunities with payers to acquire premier provider designations for hospital entities and physicians. Seeks out opportunities for new patient volumes through payer initiatives.
  • Participates in activities which result in improved contract performance, which include performing payer analysis and communicating with all Revenue Cycle teams.
  • Participates and/or facilitates regular meetings with third-party payers to ensure continuing contract performance, identify payer issues affecting payment or operations, discuss/ resolve claim issues resulting from contract interpretation and/or language, and to assist Pediatric Associates staff in developing relationships with payers.

 

EDUCATION: Bachelor’s degree in Business Administration, Finance, Accounting, Healthcare Administration or a related field. MBA highly desirable.

 

EXPERIENCE:

  • Expertise in Value Based Care contracting in a primary care environment, Medicaid and/or Medicare.
  • 10-15 years of leadership experience working with managed care contracting for a health plan, hospital and/or large physician practices, including planning, developing, managing departmental expense and budgets
  • 7-10 years progressive experience negotiating managed care contracts terms and reimbursement rates for national hospitals/medical practices and physicians.

 

KNOWLEDGE, SKILLS & ABILITIES: Strong technical knowledge of managed care contracting, payer policies, hospital and physician reimbursement methodologies, and state and regulatory requirements. Track record of successful negotiations between major payer organizations and healthcare providers. Strong organizational and interpersonal skills, with ability to communicate effectively, both orally and in writing. Ability to communicate effectively with all levels of Associates, management and senior leaders, including the ability to communicate complex technical material. Ability to lead and motivate individuals and groups of people toward the accomplishment of work and organizational goals. Excellent organizational and analytical skills.

  • Advanced data tracking and reporting abilities
  • Working knowledge of government and non-government insurance, payer requirements, and healthcare operations required
  • Excellent knowledge of healthcare revenue cycle, healthcare finance, CMS and state regulations and healthcare compliance requirements/activities required
  • Advanced ability to develop and deliver executive presentations
  • Understanding of laws and regulations as they pertain to health insurance, benefit plan designs, AHCA, CMS, etc.

 

Application Instructions

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