Vice President, Managed Care & Clinical Contracting Strategi
Company: CTI Education Group
Posted on: April 6, 2021
For application assistance, please email firstname.lastname@example.org
Representatives are available Monday through Friday from 8 a.m. to
5 p.m. CST. Job Description - Vice President, Managed Care &
Clinical Contracting Strategies (2100050) Vice President, Managed
Care & Clinical Contracting Strategies - ( 2100050 ) JOB
DESCRIPTION: Function: Responsible for the strategy, operations and
driving financial results of UTMB's managed care functions.
Position coordinates, evaluates, and oversees implementation of
managed care contracting and related operational responsibilities,
value-based contracting initiatives, selected government/county
contracts and partnering opportunities with regional employers.
Continuously monitors the competitive environment, understands, and
continuously monitors the trends that affect current and future
healthcare business models and reimbursement. Collaborates with
business development team in areas that managed care impacts
organizational strategic initiatives. Oversees revenue integrity,
provider enrollment and charge master operations, and the
institutional contract approval/review function for the
organization's authorized official. Scope: Institution-Wide
ESSENTIAL JOB FUNCTIONS:
- In conjunction with the EVP Chief Business and Finance Officer,
develops and implements managed care contracting strategy including
implementation of value-based reimbursement initiatives, county,
and lab contracts as applicable. Responsible for maintaining
reimbursement strategy and all third-party negotiations for
- Significant experience working with an employed physician
organization in deploying value-based care
- Strong understanding of and familiarity with payers and players
in the healthcare landscape
- Prior history and success leading and managing teams to deliver
- Assess and build out the managed care team and supporting
infrastructure to appropriately serve stakeholders with support and
delivery of analytic and operational resources and services to
enable success in a value-based environment.
- Development and ongoing maintenance of hospital & physician
contract management systems and staff to validate actual payments
to expected payments for services.
- Work with operations to launch models of care, monitor
performance, remove barriers, and develop and implement strategies
that enable provider adoption and success.
- Assist with development, definition, and implementation of the
organization's population health strategy to include specific
responsibility for development and implementation of value-based
reimbursement initiatives to include pay for performance, bundled
payments, shared savings arrangements & ACO participation.
- Identify and develop strategic growth opportunities, partnering
with the payer, provider, and service partners to enhance care
delivery and provider support.
- Oversight and maintenance of chargemaster for hospital &
professional services. This includes ongoing addition of new
charges in accordance with organizational pricing policies and
billing compliance regulations. Review of charge master to
evaluate/identify rate increases for both hospital & physician
services and package pricing for combined hospital and physician
- Oversight and management of provider enrollment processes for
all UTMB providers with external government (Medicare & Medicaid),
managed Medicare and Medicaid payors as well as commercial
- Development, implementation & management of revenue integrity
function to include hospital and physician charge capture, ongoing
review of revenue and usage, and identification of continued
opportunities to increase net revenue.
- Collaborates with business development team and assists with
review and recommendation of enterprise wide business development
initiatives. This includes partnerships, joint ventures,
acquisitions, and other opportunities to increase the network of
facilities and services provided by the organization.
- Assists with revenue projections and proformas for various
lines of business based on existing contracts, payor mix
assumptions, and new lines of business.
- Oversees the institutional contract approval/review function
specific to expected business and financial requirements and
routinely reviews contract provisions for renewal/termination as
required before execution by the organization's authorized
- Significant healthcare leadership experience ideally garnered
in a managed care, provider, or healthcare services setting.
- Great appreciation for the paradigm, workflow, and capability
changes necessary for primary care providers to be successful under
advanced risk-based arrangements.
- E ntrepreneurial and have knowledge and experience with
high-growth business environments including the ability to roll-up
sleeves and dig into the details of the work.
- Experience successfully partnering with providers and care
teams in a patient and provider-centric manner to effect change and
improve processes and outcomes.
- Ability to quickly gain credibility and establish the required
relationships to influence and generate results; with the goal of
quickly influencing partners to action.
- Comfortable getting into the details of operations to help
drive execution and can quickly pivot between strategy and
- Comprehensive knowledge and understanding of healthcare
financial and operational data and reporting as well as healthcare
- Comfortable leading large-scale transformation and change
- Demonstrated experience driving results. MARGINAL OR PERIODIC
- Adheres to internal controls and reporting structure.
- Performs related duties as assigned. MINIMUM QUALIFICATONS:
- Master's degree in Business or Health Care Administration.
- Minimum of ten years' experience with contract negotiation for
hospital and physician services.
- Minimum of ten years of healthcare financial/managed care
supervisory experience, including 5 years in a senior management
- Experience in implementation of new projects and team
- Experience working within an EMR
- Experience in leading virtual teams
- Experience in Change Management
- Thorough knowledge of commercial managed care, Medicaid, and
Medicare contract payment terms, healthcare finance concepts and
- Understanding of future reimbursement trends and directly
related experience in risk contracting for hospital and physician
- Excellent analytical and problem-solving skills; exceptional
verbal and written communication including negotiation and
- In depth knowledge of hospital and professional coding and
reimbursement methodologies. (i.e. DRG, APC, APG, CPT, RVU,
- Knowledge of federal, state, and local regulations, guidelines,
and standards in area of expertise.
- Ability to lead effective teams and to build and maintain
strong business relationships with internal and external
- Decisive, effective leadership skills
- Ability to provide responsive customer service and follow
through. EQUAL EMPLOYMENT OPPORTUNITY: UTMB Health strives to
provide equal opportunity employment without regard to race, color,
religion, age, national origin, sex, gender, sexual orientation,
gender identity/expression, genetic information, disability,
veteran status, or any other basis protected by institutional
policy or by federal, state or local laws unless such distinction
is required by law. As a VEVRAA Federal Contractor, UTMB Health
takes affirmative action to hire and advance women, minorities,
protected veterans and individuals with disabilities. Primary
Location United States-Texas-Galveston Work Locations 0128 -
Administration Bldg 301 University Blvd. Administration Building,
rm 6.206 Galveston 77555-0128 Job Executive Organization Univ. of
Texas Medical Branch : Regular Shift Standard Employee Status Exec
/ Faculty / Physician Job Level Day Job Job Posting Mar 30, 2021,
11:08:26 PM For application assistance, please email
email@example.com Representatives are available Monday through
Friday from 8 a.m. to 5 p.m. CST.
Keywords: CTI Education Group, Galveston , Vice President, Managed Care & Clinical Contracting Strategi, Healthcare , Galveston, Texas
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