Waterbury, Connecticut
Vice President of Coordinated Regional Care, East Coast Regi... Job Opening in Waterbury, Connecticut - Job Title: Vice President, Coordinated Regional Care-Connecticut
Reports To: Senior Vice President Coordinated Regional Care-Development and Operations East
Based: Waterbury or Manchester Connecticut
Job Summary:
Lead the execution of Connecticut CRC strategy in cooperation with corporate and local delivery system executive leadership and work with Prospect Medical Systems (PMS) and hospital staff to assure that it is executed in order to achieve clinical integration between our owned hospitals and owned and contracted physicians, best practice retention of populations under management in our own facilities and services, improved quality and patient satisfaction, cost efficiency in care delivery, highest volume of visits and admissions, competitive differentiation and best in class profitability. Lead the overall health system contracting strategy (hospitals, home health, etc.) to optimize overall relationships and financial goals with health plans and other payors in a manner consistent with the CRC strategy.
Oversee and manage the implementation and success of the CRC strategy in the Connecticut market. Collaborate with PMS and hospital leadership to drive results across CRC strategies including hospital reimbursement performance, retention and alignment with IPAs to drive and grow positive risk relationships.
Lead the development of the agenda and the accomplishment of the resulting work plans to assure that the hospital and medical group/PMS work together to increase the volume and profitability of CRC for both the operating groups in Connecticut.
In conjunction with PMS and hospital case management to review member utilization and costs and recommend and implement system improvements to increase hospital volume, retention cost efficiency and quality in the delivery of care and service to members/patients.
Work with hospital and medical group/PMS personnel to assure that the company builds a delivery system that will successfully engage the top health plans in Connecticut to contract with and drive a substantial volume of membership to the company-affiliated doctors and hospitals to further population health profitability and quality improvement.
Lead the execution of strategy for the health system payor contracting (hospitals, behavioral health, home health, etc.) to optimize overall relationships with health plans and other payors in a manner consistent with the CRC strategy. Develop strategic relationships with a sufficient number of health plans in the Connecticut market so that PMH becomes one of the major sought after risk assuming care delivery partners in the region.
Assure that we understand and meet Connecticut state risk assumption regulatory requirements. Optimize the use of our provider risk assuming entity in each market to increase volume to our hospitals and medical group/PMS. Coordinate with CAPG and CAHPs with our Government Relations team to ensure that legislative and regulatory initiatives are favorable to our business interests.
Monitor Connecticut states activity in Medicaid expansion and HIX implementation to include exploiting opportunities in the CRC strategy.
Qualification Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
:
A minimum of 10 years combined experience in health plan, physician group and hospital strategy and operations; a history of increasing responsibility in leading such activities on a large scale; a graduate degree in healthcare, business or a related field is preferred.
Bachelor?s Degree from a four year college or university is required.
An MBA is highly desirable.
At least 8-10 years of managed care contracting and network development experience ? the ideal candidate will have contracting experience with both providers such as hospitals/health systems and with payors (i.e. health plans/HMOs, etc.). Further it is strongly preferred that this individual have experience at the local level and knowledge of the Connecticut marketplace.
C-Suite experience in a managed care setting highly preferred.
In-depth understanding of provider contracting, provider development, delivery system design and operations, medical cost management, , etc.
Proven experience in the successful negotiation of contract rates and terms with sophisticated and profitable established managed care and provider organizations.
Experience in negotiating existing and new provider hospital, physician and ancillary contracts.
:
Demonstrated ability to lead health plan, physician group and hospital strategy and operations; demonstrated capability to lead efforts to clinically integrate hospitals, physicians and health plans; demonstrated ability to get things done through influence rather than direct management control.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing this job, the employee is regularly required to sit; use hands to finger, handle, and/or feel; and talk and/or hear. The employee is also occasionally required to stand and/or walk. The employee is occasionally required to climb or balance and stoop, kneel, crouch, and/or crawl. The employee might regularly lift and/or move up to ten (10) pounds. Specific vision abilities required by this job include close vision.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Job Type: Full-time
Required education:
Bachelor's
Required experience:
combined health plan, physician group and hospital strategy and operations: 4 years
managed care contracting and network development experience ? the ideal candidate will have contracting with both providers such as hospitals/health systems and with payors: 4 years
provider contracting, provider development, delivery system design and operations, medical cost management, , etc.: 4 years
successful negotiation of contract rates and terms with sophisticated and profitable established managed care and provider organizations: 3 years
|
