At the direction of the Corporate VP of Strategic Pricing & Analytics and on behalf of HCA’s Ambulatory Surgery Division President: Ensure the effective administration, coordination and support of all managed care negotiation, contracting and reporting activities on behalf of the HCA ambulatory surgery centers pursuant to the business/financial plan and SP&A policies and procedures. The Vice President of Managed Care will work with other members of the system-wide managed care department to successfully negotiate managed care contracts for HCA. The Vice President of Managed Care is responsible for coordinating the overall system contracting strategy for HCA. This individual must be able to think strategically, across multi-states, multi-markets, and all healthcare services that HCA offers, in addition to being able to analyze data and manage projects efficiently.
The ASD AVP will be officed in Dallas, TX, with oversight responsibility for all managed care contracting activities for the ASD.
- The primary responsibility of the AVP is to oversee SP&A’s optimization of the fee-for-service price/volume equation of a net revenue portfolio greater than $1.0B but no more than $1.5B
- 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 Case, Contribution Margin, etc.), and (b) be consistent with the ASD’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 other tools.
- The AVP will monitor and evaluate upcoming contract renewals by creating and utilizing new portfolio performance and renewal monitoring reporting in order to recommend renewal-specific pricing changes, and track whether the recommendations are made by SP&A negotiators. Collect key pricing requests from ASD RVPs and prioritize them for SP&A AVPs to pursue during MCO negotiations.
- The AVP will work with ASD RBOMs & RBODs to identify trended contractual rate, rate structure, or language issues and to ensure Carrier Code to Major Payor mappings are maintained
- As appropriate, the AVP may partner with MCOs on data-driven collaboration to identify opportunities to offer a savings to the MCO and patients. The AVP may need to create a quality story for SP&A AVPs to present to payors to educate them on outcomes, cost savings, and value
- The AVP must understand ASD coding, payment modeling and the revenue cycle to create preferred ASC rate template(s) with grouper methodologies, case rate carve-outs, and implant & high cost drug reimbursement and be able to identify orthopedics/spine-driven ASCs to target for Implant reimbursement add-ons.
- The AVP will research and communicate the ASD’s regional market share position, physician alignment strategies, and referral patterns and educate SP&A AVPs on trends and growth predictions to consider during the contract renewal cycle through the development of standardized About-My-Center profile reports
- Notify SP&A VPs of new services, acquisitions and ASC builds ahead of the contract renewal cycle
- Research and evaluate the pursuit of alternate payment methodologies, risk-sharing, or other care collaboration models to maximize volume access and contracting leverage. Identify ways to collect data on the care continuum to evaluate bundled and other alternative payment models.
- Ensure assimilation as a key member of HCA’s ASD operations management team (e.g., President, CFOs, VPs, including business office personnel), and provide expertise, support, 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 various other monthly reports, 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.
- Maintain current knowledge of State and Federal regulations, laws and legislative agendas regarding the healthcare industry, paying particular attention to those that involve ambulatory surgery center regulations by state, 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 CVP or ASD leadership.
Click here for more info: https://hca.taleo.net/careersection/0hca/jobdetail.ftl?job=10211-21559&lang=en
• Post ID: 50429973 northdfw