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
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