Vice President - Managed Care - FT - Days - MHS

Responsibilities

• Develops and leads strategy to preserve and enhance net revenues.
• Affirms 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.
• Makes, participates in and leads the strategic development and implementation of new product lines and alternative payment methods.
• Maintains and monitors operational issues from Managed Care Revenue Optimization, Accounts Receivable Management, or Joint Operations for solution or potential dispute resolution.
• Advocates and supports optimal operational performance by collaborating with other departments and facility leadership impacted by payer organizations policies for authorization, denials, discharge planning, pharmaceutical programs, etc.
• 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.

Requirements

• Bachelor's degree in Business Administration, Finance, Accounting, or a related field.
• Ten (10) years' progressive leadership experience in managed care required.

Qualifications

• Extensive managed care insurance and hospital industry knowledge.
• Strong technical, financial and negotiation skills.

Skills

• Executive Decision-Making
• Leading Change
• Strategic Alignment

Benefits

(Not specified)

Pay

(Not specified)

Schedule

(Not specified)