VP, Managed Care Contracting
The Vice President of Managed Care Contracting provides leadership and expertise to Sentara Healthcareâ€™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.