Vice President, Managed Care & Clinical Contracting Strategies
Employment Type : Full-Time
Function: Responsible for the strategy, operations and driving financial results of UTMB’s managed care functions. Position coordinates, evaluates, and oversees implementation of managed care contracting and related operational responsibilities, value-based contracting initiatives, selected government/county contracts and partnering opportunities with regional employers. Continuously monitors the competitive environment, understands, and continuously monitors the trends that affect current and future healthcare business models and reimbursement. Collaborates with business development team in areas that managed care impacts organizational strategic initiatives. Oversees revenue integrity, provider enrollment and charge master operations, and the institutional contract approval/review function for the organization’s authorized official.
Scope: Institution-Wide
ESSENTIAL JOB FUNCTIONS:
- In conjunction with the EVP Chief Business and Finance Officer, develops and implements managed care contracting strategy including implementation of value-based reimbursement initiatives, county, and lab contracts as applicable. Responsible for maintaining reimbursement strategy and all third-party negotiations for contract provisions.
- Significant experience working with an employed physician organization in deploying value-based care
- Strong understanding of and familiarity with payers and players in the healthcare landscape
- Prior history and success leading and managing teams to deliver results
- Assess and build out the managed care team and supporting infrastructure to appropriately serve stakeholders with support and delivery of analytic and operational resources and services to enable success in a value-based environment.
- Development and ongoing maintenance of hospital & physician contract management systems and staff to validate actual payments to expected payments for services.
- Work with operations to launch models of care, monitor performance, remove barriers, and develop and implement strategies that enable provider adoption and success.
- Assist with development, definition, and implementation of the organization’s population health strategy to include specific responsibility for development and implementation of value-based reimbursement initiatives to include pay for performance, bundled payments, shared savings arrangements & ACO participation.
- Identify and develop strategic growth opportunities, partnering with the payer, provider, and service partners to enhance care delivery and provider support.
- Oversight and maintenance of chargemaster for hospital & professional services. This includes ongoing addition of new charges in accordance with organizational pricing policies and billing compliance regulations. Review of charge master to evaluate/identify rate increases for both hospital & physician services and package pricing for combined hospital and physician services.
- Oversight and management of provider enrollment processes for all UTMB providers with external government (Medicare & Medicaid), managed Medicare and Medicaid payors as well as commercial payors.
- Development, implementation & management of revenue integrity function to include hospital and physician charge capture, ongoing review of revenue and usage, and identification of continued opportunities to increase net revenue.
- Collaborates with business development team and assists with review and recommendation of enterprise wide business development initiatives. This includes partnerships, joint ventures, acquisitions, and other opportunities to increase the network of facilities and services provided by the organization.
- Assists with revenue projections and proformas for various lines of business based on existing contracts, payor mix assumptions, and new lines of business.
- Oversees the institutional contract approval/review function specific to expected business and financial requirements and routinely reviews contract provisions for renewal/termination as required before execution by the organization’s authorized official.
- Significant healthcare leadership experience ideally garnered in a managed care, provider, or healthcare services setting.
- Great appreciation for the paradigm, workflow, and capability changes necessary for primary care providers to be successful under advanced risk-based arrangements.
- Entrepreneurial and have knowledge and experience with high-growth business environments including the ability to roll-up sleeves and dig into the details of the work.
- Experience successfully partnering with providers and care teams in a patient and provider-centric manner to effect change and improve processes and outcomes.
- Ability to quickly gain credibility and establish the required relationships to influence and generate results; with the goal of quickly influencing partners to action.
- Comfortable getting into the details of operations to help drive execution and can quickly pivot between strategy and operations.
- Comprehensive knowledge and understanding of healthcare financial and operational data and reporting as well as healthcare technology.
- Comfortable leading large-scale transformation and change management initiatives.
- Demonstrated experience driving results.
MARGINAL OR PERIODIC FUNCTIONS:
- Adheres to internal controls and reporting structure.
- Performs related duties as assigned.
MINIMUM QUALIFICATONS:
- Master’s degree in Business or Health Care Administration.
- Minimum of ten years’ experience with contract negotiation for hospital and physician services.
- Minimum of ten years of healthcare financial/managed care supervisory experience, including 5 years in a senior management position.
KNOWLEDGE/SKILLS/ABILITIES:
- Experience in implementation of new projects and team development
- Experience working within an EMR
- Experience in leading virtual teams
- Experience in Change Management
- Thorough knowledge of commercial managed care, Medicaid, and Medicare contract payment terms, healthcare finance concepts and principles.
- Understanding of future reimbursement trends and directly related experience in risk contracting for hospital and physician services.
- Excellent analytical and problem-solving skills; exceptional verbal and written communication including negotiation and presentation skills.
- In depth knowledge of hospital and professional coding and reimbursement methodologies. (i.e. DRG, APC, APG, CPT, RVU, conversion factors).
- Knowledge of federal, state, and local regulations, guidelines, and standards in area of expertise.
- Ability to lead effective teams and to build and maintain strong business relationships with internal and external clients.
- Decisive, effective leadership skills
- Ability to provide responsive customer service and follow through.
EQUAL EMPLOYMENT OPPORTUNITY:
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.
Primary Location United States-Texas-Galveston Work Locations 0128 - Administration Bldg 301 University Blvd. Administration Building, rm 6.206 Galveston 77555-0128 Job Executive Organization Univ. of Texas Medical Branch : Regular Shift Standard Employee Status Exec / Faculty / Physician Job Level Day Job Job Posting Mar 30, 2021, 6:08:26 PM