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Assistant Vice President Managed Care

Far West Division Office - Henderson, Nevada

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Job Code: 10201-20592

Full-time

No Weekends

HCA's Strategic Pricing & Analytics Team leads the strategic course for the Company in such areas as delivery system redesign, healthcare reform and strategic pricing approaches for Commercial payors;  and administers, coordinates and supports all Commercial managed care negotiations, contracting and reporting activities on behalf of the HCA facilities in the respective markets comprising the Division, pursuant to the business/financial plan and SP&A policies and procedures. 


JOB SUMMARY 

 

At the direction of the Regional VP of Strategic Pricing & Analytics:  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 payors (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 SP&A 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 SP&A AVP will be officed in Henderson, Nevada, with responsibility for the following markets: Las Vegas, Southern California, San Jose. 


GENERAL RESPONSIBILITIES

 

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 vehicle (PPMSI, an MSO that serves SCCIPA and other physician organizations in the San Jose market). 

The AVP is responsible for assisting in the preparation of the annual Market Strategic Reviews and SP&A budget packet with his/her RVP for each market. The audience should include at a minimum the SP&A CVP, 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 Payors, 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 SP&A Legal department staffs and adeptness with Qlikview and Service Line tools.

The AVP will collaborate and assist with his/her SP&A-Government Payors and SP&A-Physician Services Group (PSG) colleagues’ contracting activities with MCOs and other payors.

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 SP&A 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 SP&A senior management team, participate in strategic development initiatives as assigned by the RVP or CVP, 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 SP&A 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 Payor 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 SP&ALink, Team Room and C-Trax requirements, evaluating and processing Alternative Payment Methodology initiatives, completion and documentation (in HealthStream 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, SP&ALink 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.

Practice and adhere to HCA’s mission and values statement and code of conduct, and attend all required ethics and compliance training and retraining.

Perform other duties as may be assigned or requested by the SVP, CVP, RVP, Division CEO, Division CFO, ASD and hospital leadership.

SPECIAL QUALIFICATIONS  

 

Managed Care experience, specifically in the areas of financial analysis, payment methodologies, contract language and negotiations.  The candidate must be fluent in such systems as Word (including editing documents via redline features), Excel, Pivot Point tables and PowerPoint presentations, etc.


EXPERIENCE 

10 or more year of experience 

EDUCATION 

College Graduate Required 
Masters Degree preferred, equivalent experience considered












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Last Edited: 03/17/2017

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