VP, Managed Care Contracting

Norfolk, VA
May 05, 2017
Jul 07, 2017
Full Time
Job Description:

For additional information about this opportunity, or to be considered further, please contact Steve Kratz with Witt Kieffer at stevek@wittkieffer.com.

The Vice President of Managed Care Contracting provides leadership and expertise to Sentara Healthcare's senior management team as it relates to managed care contracting. The Vice President (VP) will be responsible for network development and contracting strategies to ensure a strong portfolio of managed care relationships is constantly maintained and to ensure that Sentara providers are paid fairly for services provided. He/she will also be responsible for managed care relationships throughout all provider divisions of Sentara, including hospitals, freestanding ambulatory care facilities, long-term care facilities, physician practices, home health agencies and medical transportation services.

The Vice President, Managed Care Contracting will work extensively and in collaboration with the senior executives within Sentara Quality Care Network (SQCN) and with Optima Health.

The VP, Managed Care Contracting is one of nine direct reports to the Senior Vice President and Chief Financial Officer. The Vice President manages a team of five.

Principle Duties and Responsibilities:

It is expected that all the duties and responsibilities of this position will be performed in a manner that reflects the values of Sentara Healthcare.

- Effective planning, development, implementation and maintenance of system wide managed care strategies and activities across the organization.
- Evaluate existing managed care contracts and determine where, if possible, consistency can be established.
- Develop and implement contract negotiation strategies for the health system and physician services, including the successful negotiation of all third-party payers contracted with Sentara Healthcare.
- Manage value-based contracts. Monitor reports tracking performance and facilitate (with the executive team) identification and implementation of actions to address areas of unsatisfactory performance.
- Provide input and recommendations on utilization and quality of care data standards that affect managed care results. Work with finance and care management teams to assure compliance.
- Oversee negotiation and implementation of contracts between Sentara employed physicians and managed care plans that will assist in strategically aligning with physicians. Supervise individual(s) responsible for implementing managed care contracts with physicians, educate physicians and office staff and monitor performance under managed care contracts.
- Work in conjunction with the information technology department and other critical areas within the organization, to develop population management resources, tools, and information.
- Develop new and innovative approaches to contracts using current and innovative reimbursement methodologies, such as bundled payments, gain sharing, incented fee-for-service models, etc. that optimize payment and reimbursement structures.
- Responsible for the effective and efficient supervision of managed care resources.
- Clearly define, establish and communicate managed care performance expectations to staff in order to achieve goals.
- Ensure that performance expectations are measured and reported through a timely, clear and transparent system of metrics.
- Participate in initiatives to develop and improve relationships with the payers.
- Supervise managed care staff responsible for executing portions of the overall managed care strategy, including hiring, preparing.
- Develop, implement, and maintain accountability for budgets with the department.

Education Level
Bachelor's degree in related field required. Master's degree preferred.

- A minimum of ten years of progressive health care experience is required. She/he will be a proven senior strategic managed care executive with established and wide range connections in the industry.
- A proven track record of significant process change/organizational improvement is required.
- Deep financial management experience is preferred.
- An experienced and visionary leader who brings judgment, wisdom and business savvy to the organization. The experience will have been gained, ideally, in a provider owned health plan or health plan environment. A leader with experience on both the provider and the payer side is a plus.
- A track record in strategic planning and execution, as well as in formulating policy, developing and implementing operational plans, new strategies, metrics, policies and procedures.
- Strong technology understanding and experience working collaboratively with information technology.
- Ideally has experience in both operations and finance and is credible among finance, strategic and clinical constituencies.
- Possesses knowledge of different payment structures such as FFS, capitation, bundled payments, and shared savings.
- Has financial background with a track record of experience and success working well with clinicians. Effective understanding of the impact of clinical practice changes on financial performance.
- Strong understanding of full range of payment structures and relative risks of each under a wide range of market and organizational circumstances. Possesses a very well developed understanding of finances of provider organizations.
- Deep understanding of net income (rather than revenue only) and its impact on various strategic opportunities.
- Extensive understanding of the synergy between managed care strategies and other strategic goals, especially growth and clinical improvement.
- Understands the differences in physician, hospital, health system and payer perspectives and is able to reconcile them.
- Understands non-financial impacts of managed care strategies on the organization.
- Effective communicator of financial payment incentives to non-financial leadership and clinical impacts to financial leadership. Able to identify clinical and operational leverage points to maximize profitability under various payment structures and explain them to other leaders.
- Possess a strong knowledge of what it takes for a health system to accept risk for a defined population including contracting, network development, clinical integration and payer strategy.
- Proven experience leading and building effective teams. Develop independent leaders capable of advancement; appropriately empowers and drives accountability through the development of a team structure that facilitates teamwork and yields high performance.

CPA preferred.

Required: Leadership, Negotiation, Social Perceptiveness, Systems Analysis

For additional information about this opportunity, or to be considered further, please contact Steve Kratz with Witt Kieffer at stevek@wittkieffer.com.

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