VP Managed Care - OU Health

General Description:

Provides strategic leadership as well as financial and administrative oversight of third party payer relations for the OU Health enterprise including the evaluation, negotiation, implementation, and subsequent monitoring/maintenance of both fee-for-service and value/risk based contracting. The OU Health Enterprise includes OU Medicine Inc. (Hospitals) and OU Physicians (Physician/Clinics), and thus this job incorporates both hospital and provider aspects of managed care contracting.

This position is a dual report to OU Health Chief Financial Officer and the Chief Administrative Officer of OU Health.

Position is responsible for a strong portfolio of managed care contracts and related programs with an emphasis on maximizing revenue and attaining operational goals of the organization. Also provides strategic direction for the development of Clinically Integrated Networks (CINs). This position acts as primary liaison within the organization and for other organizations with regard to managed care issues. Serves as a member of the senior management teams responsible for planning, allocating, and monitoring resources to support the organization's mission, strategic plan, and quality improvement initiatives.

Essential Responsibilities: Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Develops and oversees all aspects of evaluating, negotiating and implementing fee for service, value-based and special program contracts and more broadly contributes to OU Health's efforts to develop and execute strategies to strengthen OU Health's position in the evolving managed care market place.
• Responsible for assessing legal and financial implications of all contracting opportunities including new contracts, renewal contracts, contractual amendments and assignments to existing contracts.
• Develops overall managed care contracting strategy in alignment with the overall OU Health strategy
• Represents OU Health entities to all third party payers.
• Communicates and interacts with health care plan and insurance brokers, physicians, company representatives, and business community individuals to obtain market information, to negotiate claim disputes, and to clarify standards/processing requirements.
• Monitors managed care contract performance for both hospital and provider reimbursements and ensures that third party payers adhere to contract parameters.
• Develops and maintains strong relationships with internal clinical providers and groups.
• Serves on boards, committees, and councils as assigned or as appropriate as company representative; coordinates and schedules presentations related to managed care functions, resources, and strategies.
• Provides direction and oversees management of area and develops and implements policies and procedures for area of responsibility.
• Strategy development includes market assessment, financial modeling, relationship management with employers and payors.
• Monitors the public and fiscal environments to predict/evaluate potential impact on current and future contract activity.
• Hires, trains, develops, coaches, supervises, counsels, and evaluates Managed Care staff; develops and communicates program processes and procedures.
• Ensures orientation, in-service education, competency, and continuing education of all persons in areas of responsibility.
• Continuously assesses and improves areas of responsibility in accordance with performance improvement plans.
• Prepares and submits budgets for managed care programs in accordance with established deadlines; monitors budget compliance and takes corrective action for deviations as needed
• Integrates areas of responsibility with the health system's primary functions and other departments in accordance with health system strategic and operational plans

OU Health:

• Responsible for Managed Care Contracting Committee which will review and recommend contracts to the OUH Board.
• Recommends to the Board managed care contracting parameters and guidelines, including compensation and risk parameters and delegated credentialing

OU Physicians

• Responsible for Managed Care Contracting Committee which will review and recommend contracts to the OU Board of Regents
• Recommends to the OU Physicians Operations Council managed care contracting parameters and guidelines, including compensation and risk parameters and delegated credentialing

General Responsibilities:

• Perform other duties as assigned.

Minimum Qualifications:

Education: Master's Degree required.

Experience: 7 to 10 years of progressively more responsible management experience in the managed care or clinical health care environment with emphasis on contracting, finance, or operations. Work experience in an academic medical center strongly preferred.

License(s)/Certification(s)/Registration(s) Required: N/A

Knowledge, Skills and Abilities:

• Results oriented with strong business and financial acumen and a deep understanding of the role Managed Care plays in helping the organization achieve its business goals.
• Demonstrated knowledge of managed care including both hospital and physician elements, including managed Medicare and Medicaid, and other payor's guidelines and criteria for reimbursement.
• Facile with insurance billing, coding and terminology.
• Knowledge of ongoing healthcare trends, legislation, and reimbursement standards.
• Requires legal knowledge sufficient to understand and draft contract documents.
• Work requires strong negotiating skills, as well as strong analytical and strategic thinking capabilities.
• Possesses ability to plan, direct and supervise the work of a diversified staff.
• Work requires ability to work in large, complex matrix organizations.
• Work requires strong team building skills to gain consensus of multiple entities on contracting issues.
• Requires financial skills sufficient to evaluate or produce complex fee schedule analysis.
• Consistently demonstrates solid organizational skills, time management, and professionalism.
• Must possess advanced interpersonal skills to effectively interface with all levels of faculty and staff as well as external business-related associates.
• Demonstrated ability to develop collaborative relationships with key stakeholders. Strong influence skills and ability to motivate others.
• Must demonstrate the ability to provide leadership and effectively communicate both verbally and in writing to all levels within the organization.
• Proficient with the use of Microsoft Office tools.