What are the responsibilities and job description for the Chief Managed Care Officer position at Mercy Health BSMH?
CHIEF MANAGED CARE OFFICER | REMOTE
The Chief Managed Care Officer (CMCO) will have enterprise-wide managed care contracting responsibility spanning the enterprise’s entire portfolio of hospitals, ancillary providers, and employed physicians. This high performing leader will set the vision for the future relative to where, how, and who the system contracts with to optimize the overall goals of the organization. This includes fostering effective working relationships with payers, brokers, local and national employers, affinity groups, city governments, and internal stakeholders.
The successful candidate will enhance the efficiency and quality of the organization’s cost structure through innovative value-based contracting strategies. It is paramount this leader grow professionally, well beyond the current size of the organization and the scope of the position as it exists today.
Essential Job Functions.
- Design, implement, and optimize an industry-leading payment contracting strategy for the entire health system to include the development of a broad vision, short- and long-term objectives, execution of key business initiatives across all payers, both private and government.
- Quickly establish himself/herself as a credible leader by demonstrating forward thinking, a focused approach to executing strategic initiatives, and a high level of integrity.
- Recruit, develop, and continually assess leadership and support personnel within the organization. Stay ahead of “the curve” relative to building a talent pipeline in anticipation of future staffing requirements, which parallels the strategic direction of overall.
- Serve as the strategic architect, knowledge expert, and leading voice for government, commercial and employer payer contracting, and relations.
- Work with Financial Leadership Team (FLT) to establish and implement financial and operational parameters and processes for large payer negotiations and any new type of payment contracting strategy (e.g., Direct to Employer).
- Collaborates with Analytics to develop predictive financial contract yield models for new and/or existing reimbursement terms.
- Maintain a keen awareness of the external business environment and competitive landscape and comprehend opportunities to garner new payer agreements and/or favorable payment provisions and strategic patient retention.
- Cultivate strategic relationships within the payer and employer and government communities to create opportunities to promote the enterprise’s corporate strategy and address key challenges (e.g., accounts receivable, down coding, denials, medical policy).
- Inspire and provide professional guidance to key direct report staff as they successfully negotiate payer agreements within established and agreed upon parameters.
- Serve as a resource concerning managed care and government reimbursement trends, payer relations, and general payer knowledge.
- “Translate” payer contract obligations, purpose, and objectives to the senior leadership team, and support communications, operations, legal, and other key stakeholders.
- Achieve budgeted rate increases, while also leading the way to implement innovative payment models that support the organization’s evolving delivery system.
Required
- Master’s degree in business administration, healthcare administration, public health, or closely related field
- 10 years’ payer or provider experience in managed care contracting experience, specifically in the areas of financial analysis, payment methodologies, contract language and negotiations
- Previous experience in an advanced managed care contracting environment in all relevant settings (acute care, ancillary providers & employed physicians) with a deep understanding in value-based arrangements, risk contracting and/ or bundled payments
- 5 years’ of leadership experience
- 5 years’ experience using data analytics and financial modeling applications, including but not limited to Microsoft Excel and database applications
Skills
- Strategic agility
- Developing, communicating strategic vision
- Thought leadership
- Comfort operating in ambiguous regulatory environment
- Integrity and confident humility
- Negotiation
- Recognition, mentoring, and staff development
- Managing relationships with internal and external partners, peers, subordinates, and senior leadership
- Professionalism in demeanor and presentation
- Effective listening, reframing issues cogently, and promote ideas with honesty and facts
- Analysis and reporting of data, financial, and risk
- Written and verbal communication and presentation skills, especially with complex topics
- Financial modeling
- Legal and contractual compliance
- Timeliness, project oversight, and prioritization
- Critical thinking
- Professional aspiration and desire to grow
- Persuasive, professional, and innovative
- Influencing with integrity
- Ability to make tough decisions with confidence even during times where a high level of ambiguity exists
Comprehensive, affordable medical, dental and vision plans
Prescription drug coverage
Flexible spending accounts
Life insurance w/AD&D
Employer contributions to retirement savings plan when eligible
Paid time off
Educational Assistance
And much more
*Benefits offerings vary according to employment status
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com
