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VP, Managed Care

Facility: CHS Services Inc Location: Melville, NY Department: Managed Care Category: Leadership Schedule: Full Time Shift: Day shift ReqNum: 6018950

Position Summary:

Develops and implements the managed care strategies of the organization for the hospitals,home care, nursing homes, hospice, Maryhaven, joint ventures as well as the employed and IPA physicians. Develops and implements alignment models such as pay for performance, bundled payments and various forms of risk contracting. Negotiates and administers contracts with managed care payers.

Responsible for planning, evaluating, and implementing the various managed care programs (HMO's, PPO's and long term care) for Catholic Health Services (CHS).? Establishes quality and financial performance standards for managed care contracts and products and monitors performance.? Negotiates contracts with managed care companies, IPAs, TPAs and self insured plans..?

Duties & Responsibilities:

  • Develops, quantifies, and executes negotiation strategies for CHS.
  • Advises management in the overall direction of CHS managed care and its impact on business development.
  • Establishes annual budget goals for managed care contracts; monitors and reports progress through the year.
  • Responsible for the management and direction of the Managed Care Department including personnel management, setting of department policies, goals, objectives, and preparation, administration and control of departmental budget.
  • Facilitate continuous improvement of financial performance, operations, and compliance related to payer contracts.
  • Creates long and short term strategic pricing objectives based on historical contract performance and expected future trends.
  • Develops organizational and informational tools necessary to achieve financial goals as contracts evolve to incur increased accountability and risk.
  • Assures all contracts and processes comply with corporate policies and standards.
  • Works closely with quality and clinical staff on the development of new and innovative payment structures and methodologies that maximize financial benefit and minimize exposure.
  • Develops, implements, and monitors a detailed contracting process for renewals to achieve timely completion, maximum results, and appropriate feedback and approvals.
  • Facilitates continuous improvement of financial performance and operations by establishing and maintaining standards for hospital contract language and payment methodology. Ensures that CHS maximizes managed care revenue by securing optimal contract language, terms and rates.
  • Works with the physician enterprise and IPA leadership on maximizing managed care revenues through the development of long and short term strategic goals.
  • Coordinates internal and external communications regarding payer issues and negotiations.
  • Works closely with revenue cycle and legal to develop, evaluate and execute dispute resolution strategies for payer issues. Provide leadership, direction and technical support in various areas affecting the revenue cycle including managed care contracting and compliance, physician practice compliance with payer policies and procedures, denial management and appeals.
  • Evaluates and assists in the training of staff on an ongoing basis
  • Interacts with other operational departments to ensure execution of cohesive strategies (e.g., MIS, Operations Finance, Physician Practice Management).Works with MIS to develop supportive systems that collect data necessary to ensure leading class practices for maximizing revenue.
  • Oversees state regulatory application and certification processes required when accepting risk.
  • Researches, monitors, interprets and prepares CHS for changes in performance, market trends, and federal/state health reforms. Develops the appropriate business development action plans.

Requirements and Qualifications:

  • At least 10 years related experience. Payer and provider experience preferred. In depth knowledge of managed care concepts, practices and procedures.
  • Master's degree in related field.
  • Strategic thinker, goal oriented, ability to work independently.
  • Excellent communication and presentation skills

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