Assistant Vice President Managed Care
HCA, a Fortune 100 company with more than 200,000 employees, is one of the nation's leading providers of healthcare services, operating over 170 locally managed hospitals and over 100 freestanding surgery centers in 20 states and the United Kingdom. With its founding in 1968, HCA created a new model for hospital care in the United States, using combined resources to strengthen hospitals, deliver patient-focused care and improve the practice of medicine. HCA is a learning healthcare system that uses more than 27 million annual patient encounters to advance science, improve patient care and save lives. HCA has been named one of the world's most ethical companies for eight years in a row. At HCA, we are driven by a single goal: the care and improvement of human life.
At the direction of the VP of Payer Contracting and Alignment: Participate in developing the strategic course for the Company in such areas as delivery system redesign, healthcare reform and strategic pricing approaches for Commercial payors; and Administer, coordinate and support all Commercial managed care negotiation, contracting and reporting activities on behalf of the HCA facilities in the respective Divisions/Markets comprising the Region, 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 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 dollars but no more than $2.5B dollars which includes hospitals, ambulatory surgery centers and various ancillary provider types.
• The AVP is responsible for preparing the annual Division Strategic Reviews with his/her VP for each division. The strategic review should include at a minimum the Division CEO and CFO. The Strategic Reviews need to be completed by July 31st of each year. The AVP will ensure that all required processes and available strategic pricing tools
• Participate in the successful coordination, negotiation and implementation of contracts with Managed Care Organizations (MCO's), and maintain effective working relationships with counterparts at such MCOs.
• Ensure that all required processes and available strategic pricing and tactical tools will be deployed in order to both (a) maximize contract performance/yield (e.g., Net Revenue, Net Revenue per Adjusted Admission, Contribution Margin, etc.), and (b) be consistent with pricing and EBDITA bandwidth management objectives.
• The AVP will assist in coordinating negotiations that include managed government products with commercial products collaborating, assisting and participating in those negotiations.
• As a key member of the PCA senior management team, participate in strategic development initiatives as assigned by the VP, including but not limited to such things as alternative payment methodologies (e.g., capitation, pay-for-performance, bundled payments, etc.), contracting practices (e.g., language standards, creative/protective provisions, etc.), healthcare reform (e.g., ACOs, VBP, HIX, etc.), subject-specific task forces, etc.
• Ensure assimilation as a key member of Division/Market operations management team (e.g., Presidents, CEOs, CFOs, COOs, CNOs and Directors, including hospitals, ASCs, and IDTFs ), and provide expertise, support, constituent 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 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 Division Reviews and Contract Strategy Presentations (as applicable), adhering to Contract Process and approving Contract Strategy Documents, evaluating and processing Alternative Payment Methodology initiatives, completion and documentation (in HealthStream or in-person attendance) of annual Code of Conduct and other required training activities, business/travel expense processes through Concur (both for self and in approving subordinates' reimbursement requests), human resources policies and procedures relative to direct reports (e.g., use of 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, and provide copies of finalized documents to the Shared Service Center, ASD, and other operational counterparts as may be applicable to the contract in question, on a need-to-know basis.
• 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 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, VP, Division CEO/CFO, ASD and hospital leadership.
More than 7 years of experience
Undergraduate Degree Required. Masters Degree Preferred, equivalent experience considered
Managed Care experience, specifically in the areas of negotiations, financial analysis, payment methodologies, and contract language.
20% travel required.