AVP Managed Care

Company: St. David s HealthCare
Location: Pflugerville
Posted on: July 29, 2022

Job Description:

Description IntroductionDo you want to join an organization that invests in you as a(an) AVP Managed Care? At ST. David's Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.BenefitsAt ST. David's Healthcare, we want to ensure your needs are met. We offer eligible colleagues an attractive benefit package that includes medical, wellbeing, dental and vision benefits along with some unique benefits including:

• Medical, Dental, Vision, Life Insurance and Flexible Spending
• Paid Time Off (PTO) and Personal Leave
• 401K (100% annual match - 3% to 9% of pay based on years of service)
• Academic Assistance and Reimbursements for Tuition and Student Loans
• Employee Discounts including Tickets, Retail, Mental Health Apps, Education Apps, Identity Theft Protection etc.
• Home, Auto, and Pet Insurance
• Employee Stock Purchase Program (ESPP)
• Short Term & Long Term Disability coverage
• Adoption Assistance
• Legal Benefits and lots more!Learn more about Employee BenefitsYou contribute to our success. Every role has an impact on our patients lives and you have the opportunity to make a difference. We are looking for a dedicated AVP Managed Care like you to be a part of our team.Job Summary and Qualifications At the direction of the VP or Regional VP of Payer Contracting and Alignment, you will participate in developing and execution of the strategic course for the Company in such areas as delivery system redesign, healthcare reform and strategic pricing approaches for Commercial payers (including Health Insurance Exchange QHPs); and administer, coordinate and support all Commercial managed care negotiation, contracting and reporting activities on behalf of the HCA facilities in the respective markets comprising the Division, pursuant to the business/financial plan and PCA policies and procedures. Note: This is a senior level position within the Company, with significant revenue responsibilities and requiring a high-level understanding of healthcare financing and delivery and the ability to think strategically and offer innovative solutions to the complex challenges facing both the Company specifically and the healthcare industry in general (in addition to the ability to successfully manage day-to-day operational responsibilities). The PCA AVP will be office in Texas, with responsibility for the following markets: Austin and El Paso Your responsibilities will include:
  • The primary responsibility of the AVP is to optimize the fee-for-service price/volume equation of a Commercial net revenue portfolio greater than $1.0B but no more than $2.5B, and which includes hospitals, behavioral health facilities, provider-based (free-standing) emergency departments, ambulatory surgery centers and various ancillary provider types, and also having significant connectivity with the Company s employed physicians (PSG) and physician alignment vehicles. The AVP is responsible for assisting in the preparation of the annual Market Strategic Reviews and PCA budget packet with his/her VP or RVP for each market. The audience should include at a minimum the PCA VP, Division CEO and Division CFO. The AVP will oversee the successful coordination, negotiation and implementation of Commercial contracts with Managed Care Organizations (MCOs) and other Commercial Payers, and to maintain effective working relationships with his/her counterparts at such entities. The AVP will ensure that all required processes and available strategic pricing, legal, reporting and communication tools and processes will be deployed in order to both (a) maximize contract performance/yield (e.g., Net Revenue, Percentage of Charge Revenue, Net Revenue per Adjusted Admission, Contribution Margin, etc.), and (b) be consistent with the Division s EBIDTA and pricing bandwidth management objectives. Among these requirements will be maintaining an effective working relationship with the Analytics & Pricing Services (A&PS) and PCA Legal department staffs and adeptness with Qlikview and Service Line tools. The AVP will collaborate and assist with his/her PCA-Government Payers and PCA-Physician Services Group (PSG) colleagues contracting activities with MCOs and other Payers. The AVP will be heavily involved in denial management activities, from avoidance (by securing robust contract protections) to information gathering (via regular meetings with Case Management and SSCs, maintenance of Denial Activity Tracker form and participation in DMAT) to resolution (via JOCs and other problem-solving interfacing with the MCOs) to disputes (via involvement with PCA Legal, SSC Legal and other dispute resolution processes). Supervise, oversee and develop direct reports (if any/as applicable) in accordance with their job descriptions, all Company requirements and the dictates of personnel management best practices. As a key member of the PCA senior management team, participate in strategic development initiatives as assigned by the RVP orVP, including but not limited to such things as alternative payment methodologies (APMs, e.g., capitation, pay-for-performance (P4P), bundled payments, patient-centered medical homes, etc.), contracting practices (e.g., language standards, protective provisions, etc.), healthcare reform (e.g., CIN, ACO, VBP, HIX, BPCI, CJR, Population Health-based analytics, etc.), delivery system redesign opportunities (e.g., employer engagement and/or direct contracting, collaboration with PSG colleagues, assistance with physician alignment vehicle, etc.), subject-specific task forces, etc. Ensure assimilation as a key member of HCA s Group/Division/Market/Facility operations management team (e.g., Presidents, CEOs, CFOs, COOs, Development and Service Line VPs, CNOs and Directors, including hospitals, ASCs, IDTFs and PSG), and provide expertise, support, consumer advocacy, education, involvement in legislative issues, budgeting tools and other communication strategies to ensure a commonality of understanding, purpose and direction in all market-based PCA activities. Comply with standard Company reporting and signatory requirements, including but not limited to timely submitting Monthly Operating Report (MOR) attestations and various other monthly reports (e.g., Major Payers Update, ASC Update, Completed Contracts Report, Behavioral Health Update, HIX/Narrow-Network Update, etc.), overseeing preparation and conduct of annual Strategic Market Reviews and Contract Strategy Presentations (CSPs), adhering to Contract Process and related PCALink, Team Room and C-Trax requirements, evaluating and processing Alternative Payment Methodology initiatives, completion and documentation (in Health Stream or in-person attendance) of annual Code of Conduct, Physician Relationship, Information Protection and other required training activities, business/travel expense processes through Concur, human resources policies and procedures (e.g., use of TMS/Authoria system for goal-setting, performance evaluations, etc.), and so on. Ensure that a permanent record of all negotiations and documentation relating to Commercial MCO contracting activities is maintained in local files, electronic files, PCALink and/or C-Trax (or as may otherwise be permitted/required); provide copies of finalized documents to the SSC and (as applicable) Ambulatory Surgery Division (ASD) and PSG; and provide in-servicing and other summary documents to PSG, SSC and Case Management colleagues, on a need-to-know basis, in order to enable them to better operationalize such MCO contracts. Maintain current knowledge of State and Federal regulations, laws and legislative agendas regarding the healthcare industry, paying particular attention to those that involve healthcare reform, managed care, ERISA and health insurance.
    What qualifications you will need:
    
    • Bachelors Degree is required; Master s Degree preferred, equivalent experience considered
    • Managed Care contract negotiation experience, whether for a hospital system or MCO
      
    • 10+ years of experience
    • The candidate must be fluent in such systems as Word (including editing documents via redline features), Excel, Pivot Point tables and PowerPoint presentations, etc.
      
    • Managed Care experience, specifically in the areas of financial analysis, payment methodologies, contract language and negotiations. HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry. HCA Healthcare has been named one of the World's Most Ethical Companies by Ethisphere Institute for over a decade. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses."Good people beget good people."- Dr. Thomas Frist, Sr.
      HCA Healthcare Co-FounderWe are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our AVP Managed Care opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
      CORP-AFHPThis position is incentive eligible.

Keywords: St. David s HealthCare, Pflugerville , AVP Managed Care, Other , Pflugerville, Texas