Vice President Managed Care

Req # 28565 Position Expectations Reporting to the Vice President, Coordinated Regional Care PA & NJ with a dotted line relationship tothe Vice President, CRC National Managed Care Contracting, the Vice President of Managed Care is essential to the success and financial stability of Crozer Keystone Health System (CKHS) through thedevelopment and enhancement of relationships with health plans and other Payors to secure optimal reimbursement and protect the interests of CKHS through the development, implementation, interpretation and administration of managed care contracts. Of key importance are the planning, organizing, directing and conducting of  contract negotiations, and the implementation and oversight ofthose managed care agreements. Additionally, this position is responsible for ensuring effective coordination and collaboration between theManaged Care Department and other functions, such as: Operations, Business Development, Marketing, Finance, Physician Integration, Communications, Legal, Revenue Cycle and Prospect Provider Group, PA (PPGPA)   Duties and Responsibilities   Leads the planning and creation of managed care strategy in specific market areas designed to help health plans and other payers move forward in Prospect's Progressive Risk continuum.   Develops all managed care initiatives, goals and activities including, but not limited to, Hospitals, Medical Groups, Home Health and Ambulatory Services Collaborates with Physician and other leadership to plan, evaluate and negotiate various fee-for-service, value based and risk contracts Manages the design, implementation and maintenance of managed care data base, analytics and educational materials. Provides a written scope of services, departmental policies and procedures that guide and support the provision and integration of contracts. Regularly educates managed care payers and their clinical decision makers on the value proposition offered by Crozer-Keystone Health System Monitors quality and healthcare cost performance improvement activity as it relates to contractreimbursement. Develops community-based managed care strategy leveraging existing contracts Develops relationships at the C Suite level with managed care organization Acts as a liaison with health plans on significant claims-related issues involving CKHS department or physicians. Identifies CKHS program development initiatives and develops managed care plan proposals in collaboration with appropriate CKHS executives Monitors market for legal and regulatory developments in Healthcare as it relates to changes in thePayor landscape. Represents the organization in a positive, professional manner in the community and among other Managed Care and related professional organizations Communicates and prepares reports on managed care activity in the market Collaborates with the Finance and other Departments in contract negations, and in evaluation ofcontract performance and compliance Collaborates with Business Development and Marketing to develop strategies to grow market share.     Requirements   Strong analytical and negotiation skills with exceptional verbal and written communication skills Excellent presentation and organizational skills Outstanding managerial skills to coordinate support from multiple internal departments Ethical and enthusiastic with strong work ethic Competitive with a passion to excel   Qualifications:   Minimum 10 years' prior relevant management experience with at least 10 years' experience in a healthcare and/or insurance managed care function BS or BA degree is required.  MBA, MHA or equivalent graduate degree or commensurate experience in a managed care or similar health care environment is strongly preferred.   ACHE or FACHE would be valuable Proven experience reviewing, analyzing and effectively negotiating and administering contracts. Must be able to resolve problems, handle conflict, and make effective decisions under pressure Demonstrated experience effectively managing and supervising a high performance team Bright, creative, high energy and outgoing   Apply
Salary Range: NA
Minimum Qualification
11 - 15 years

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