Executive Director, Managed Care
Under the general supervision of the Regional Sr. VP, Managed Care, position will work closely with Market President and senior Steward leadership to define and execute payer strategies and established collaborative payer and broker relationships. As the local lead for the Managed Care team, the Executive Director will negotiate reimbursement rates, legal terms, performance programs, and risk arrangements with managed care plans for Steward hospitals, physicians, and ancillary providers on behalf of Steward Health Care Network (“SHCN”). The Executive Director will recommend and execute tactics and objectives for negotiations that will expand Steward’s covered lives and maximize SHCN financial performance and overall Steward value.
- Under the general direction of the SVP and Market President lead the payer strategy development specifically directed at increased SHCN covered lives:
- Expanded product and plan development and participation
- Expand direct to purchaser / broker channels
- Establish strong local knowledge and relationships to help drive regional strategies with payers and employers.
- Direct self-insured lives to network
- Collaborate with Onsite to drive lives to network
- Contribute to overall development and implementation of local Managed Care strategy and tactics for the applicable region to maximize Steward value:
- Clinical Integration, Patient Engagement and Population Health Management
- Advancement of clinical quality performance for hospital and physician
- With guidance, execute on Steward’s vision to be a leading value-based health care system, and incorporate such vision into the overall Managed Care strategy and tactics. Strong contributor to building Steward’s brand value in the Utah Market Support brand recognition as a high quality low cost provider
- Recommend and effect direction, develop and preparation of financial and risk analysis to support the strategic goals of Steward
- Develops effective relationships with critical payer counterparts in the marketplace into order to position Steward to be able to effectively negotiate and develop expanded partnerships with the payers.
- Develops effective relationships with key stakeholders within Steward, to include the SHCN Leadership, Hospital Division Leadership and SMG leadership, as well as other executive and corporate leadership, hospital administrators and physician leaders.
- Effectively collaborate and coordinate with Regional SHCN VP and other key internal stakeholders to advance the overall Managed Care Strategy and performance goals. Create and effectively communicate financial and risk terms with internal and external leadership.
- Secures support for negotiation goals and positions with both internal and external constituents through strong and effective persuasive skills and technical knowledge
- Develop and build models and perform monthly and ad hoc analysis for the purpose of understanding the historical, current and future performance of existing contracts.
- Works closely with the Steward hospitals and physician groups to identify systemic issues (e.g., claims, underpayments, denials) and develops resolutions that can be addressed in the contract negotiations.
- Monitors, interprets, and reports on changes in performance, market trends, health care delivery systems, and legislative initiatives that impact managed care and market efforts (e.g., CMS, ACO regulations, Massachusetts Health Reform, etc.).
- Provides support for the key Steward Health Care Network (SHCN) leadership meetings including: Hospital President Meetings, local SHCN Board Meetings, and SHCN Negotiation Committee meetings.
- Serve as resource on fiscal and legal provisions of the contracts. Coordinates closely on key contracts with local leadership and legal department.
- Define and lead resolution process with providers and health plans to address system-level claims.
Required Knowledge & Skills:
- Demonstrated strong market and payer knowledge and ability to forge partnerships to expand SHCNs footprint in Utah
- Expertise in developing and assessing risk and FFS reimbursement models.
- Understanding of the health care delivery setting including both hospital and physician reimbursement and claims processing.
- Strong product knowledge and ability to actively participate in product design with purchasers and plans
- Education: Bachelor’s degree or equivalent combination of education and experience; Master degree preferred.
- Experience (Type & Length): Minimum of five to seven years operations experience in a health plan preferably including both commercial and government contracting.
- Software/Hardware: Competent in the Microsoft products including Excel and PowerPoint
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
Job Status: Full Time
Job Reference #: 13406