VP, Hospital Contracting & Washington Managed Care Job
VP, Hospital Contracting & Washington Managed Care
This position is based in Washington, DC
Job Summary: This position is responsible for the managed care initiatives impacting Medstars Washington Region and the proper and successful implementation of the managed care contracts for MedStars hospital business units. Management of a senior level work group and regular involvement in the development, execution of goals, strategies, and plans across District of Columbia hospital facilities.
Education: An undergraduate degree is required, and a graduate degree in a relevant field such as business administration, public health, or health administration is preferred.
EXPERIENCE: A minimum of ten years progressively responsible experience in healthcare, delivery systems, or managed care, with at least five years experience in a senior role, ideally with an organization with substantial experience with managed care relationships. Must be a knowledgeable leader with extensive managed care experience with knowledge of both payer and provider settings. Strong familiarity with healthcare provider networks and their underlying contractual arrangements; an in-depth understanding of financial and other incentives that impact managed care product design and service delivery. Knowledge of traditional and innovative managed care products, and an understanding of evolving reimbursement arrangements.
Skills: Must possess a variety of technical abilities, professional competencies, and personal characteristics to successfully meet the position requirements. Highest level of problem solving is required. The ability to articulate a vision of a leading edge managed care strategy, to communicate the steps required to achieve a position of leadership in the marketplace, and to direct the organization to achieve that vision.
Primary Duties and Responsibilities
Develops and contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations. (MANAGEMENT)
Responsibilities will include the identification and resolution of very complex problems, such as developing innovative solutions based on extensive cross-functional knowledge of the entire MedStar Health organization.
Lead managed care initiatives impacting MedStars Washington region. Scope includes managed care initiatives for MedStar Washington Hospital Center, MedStar Georgetown University Hospital, and MedStar National Rehabilitation Network. Incumbent directly impacts system goals and objectives related to revenue and strategic positioning.
Provide leadership and direction for managed care team supporting Washington-based entities, including financial management, managed care information systems, claims administration, customer service, utilization management, and medical affairs.
Serve as chief negotiator with oversight for all managed care negotiations for MedStar Washington Hospital Center, MedStar Georgetown University Hospital and MedStar National Rehabilitation Network, as well as contracting for MedStars seven HSCRC-hospitals.
Serve as principal negotiator for transplant and global services.
Serve as principal negotiator for all globally-priced agreements that are administered through the WHC-PHO.
Oversee the proper and successful implementation of managed care contracts internally and ensure that contracts are managed effectively and maintained and that provisions are evaluated and monitored constantly toward optimal reimbursement and operational effectiveness.
Monitor and evaluate payment trends and compliance with contractual rates and terms by managed care payers. Serve as liaison between Patient Financial Services and payers to ensure proper interpretation and administration of contracts
Serve as principal communicator with clinical leadership at Washington-based MedStar hospitals toward maintaining effective interface between clinical and managed care operations.
Maintain knowledge of medical management issues, emerging clinical technologies and other issues affecting clinical operations and program development.
Monitor payer utilization management activities and oversee provider strategies for effectively challenging payer reimbursement decisions.
Maintain and/or increase levels of business from current managed care contracts and identify opportunities for providers and formulate appropriate action.
Evaluate the impact of managed care contractual relationships on financial, operational, and strategic results so as to maximize the relationships.
Educate and work closely with internal constituents, including admitting, patient accounts, finance, legal services, utilization review, clinical department heads, and physicians regarding contract requirements, procedures, and policies for the various managed care contracts.
Provide leadership and direction for all Washington-based Managed Care associates, including contracting, payer relations, promotion of MedStar services to payers, financial management, product development, provider network development and support, customer service, and managed care issues impacting utilization management and medical affairs.
Build and retain high-caliber professional team essential to a high performance division. Responsible for motivating and engaging staff, leading change, building trust and consensus, and appropriately delegating and empowering staff.
Serve as a liaison for MedStar entities (above) to payers on all matters related to contractual agreements.
Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
Performs other duties as assigned.
REPORTS TO: Reports to Vice President, Managed Care, MedStar Health.
SUPERVISES: Manages staff in the Washington Managed Care office as well as some in Baltimore supporting hospital contracting.
Facility Location: MedStar Health Corporate Offices
Nearest Major Market: Baltimore
Job Segments: Rehabilitation, Clinic, Claims, Product Development, Public Health, Healthcare, Insurance, Research