Vice President of Managed Care Contracting

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Department:

Job Summary:

Under the direction of the Chief Financial Officer, the Vice President of Managed Care Contracting promotes and directs all managed care-contracting efforts on behalf of the hospital. The Vice President of Managed Care Contracting will be responsible for all payer contracting, along with direct employer contracting. The Vice President of Managed Care Contracting also provides leadership for the business initiatives of the organization, with regard to managed care strategic development. This position requires the individual to be “hands-on”, with no staff reporting to them. The responsibilities include negotiating, implementing and maintaining all payer and direct employer contracts and the respective policies for each. The Vice President of Managed Care Contracting keeps abreast of all managed care marketplace activities and logically and cohesively adjusts strategies accordingly. The Vice President of Managed Care Contracting will also provide consultative support to the executive team on organization wide contracting efforts and manage all governmental funding sources available to the District.

Primary Duties:

1. Accountable for the negotiation, implementation, administration and financial tracking of all managed care contracts for the health system.

2. Responsible for understanding and facilitating external funding opportunities such as intergovernmental transfers, low-income health programs and delivery system improvement programs.

3. Administers operational dashboards for payer classes, monitoring contract compliance and tracking denial issues in collaboration with Case Management Department.

4. Leads and maintains collaborative payer and employer relationships and serves as the liaison to business, government and the public in relation to managed care contract matters.

5. Maintains current knowledge of managed care principles and oversees the achievement of targeted contractual levels.

6. Serves on the Revenue Cycle Committee as the managed care contracting representative, providing data and support to the committee.

7. Oversees key revenue enhancement efforts of the organization, including supplemental funding, revenue
recovery management and payer discrepancies and/or disputes.

8. Identifies opportunities for improvement in managed care contracting and contractual performance with input
from Case Management, Patient Financial Services, Registration and/or other departments.

9. Oversees the day to day collection of clinical, financial, and contracting data needed, for the analytical support of the payer contracting process and hospital business development efforts.

10. Serves as support role to the Chief Financial Officer, accomplishing key tasks as assigned.

11. Promotes the Hospital as the leader in the provision of quality healthcare services to the public and the provider community.

12. Performs other duties as assigned.

Education: Bachelor’s degree required. Master’s degree preferred.

Licensure: None.

Experience: Five (5) years experience in managed care contracting at a senior level.

• Extensive managed care contracting experience in a mid to large size acute care hospital in California and a major health plan.

• Senior-level experience in performance and risk-based contracting, modeling and reporting is required.

• Experience in developing a strategic plan to address the regulatory affordability issues of healthcare organizations.

• Several years of experience in developing and operationalizing a commercial product in the service market for a health system.

Job Specifications:

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!