Vice President, Managed Care Admin

PEOPLE ESSENTIAL FUNCTIONS

• Provides direction to management team to enable the effective and efficient completion of objectives. Gives timely guidance and feedback to direct report management to strengthen their specific knowledge/skill areas needed for progression. Holds direct reporting management team accountable for the development of staff to meet overall objectives in terms of quality, service and cost effectiveness.

• Identifies opportunities and takes action to build strategic relationships between one's area and other departments to achieve business goals. Works collaboratively with stakeholders to foster a climate of open communication and mutual problem-solving.

• Develops efficient organizational structures within scope of assignment. Provides leadership for management team to maintain a competent and engaged employee group and provides recognition/commendations to achieve desired outcomes. Drives initiatives to meet or exceed threshold goal for department turnover and/or system metrics on employee engagement indicators.

• Develops and maintains strong relationships with executives of payer organizations. Serves as a conduit for future business relationships.

• Represents HM to the payer organizations, enrollees and community leaders.

SERVICE ESSENTIAL FUNCTIONS

• Develops and implements strategic and operational/high level projects and processes. Sets clear goals, priorities and objectives for the direct report management team. Oversees multiple departments' operations and designated projects to ensure that goals or objectives are accomplished within the prescribed time frame, providing guidance to management team to ensure the best possible delivery of service and high customer/patient satisfaction.

• Drives HM service standards and activities to impact system score for patient/customer-based satisfaction, through role modeling and fostering accountability. Responsible for the overall successful operation of the direct report management team.

• Drives collaboration across the organization to identify needs and develop scalable solutions. Prioritizes objectives and implements strategies to achieve organization initiatives as part of the executive leadership team. Delegates responsibilities to direct report management, providing guidance and direction, as appropriate.

• Oversees analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.

• Disseminates important HM accomplishments to payer executives and medical directors to support awareness and promote understanding.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Reviews levels of service and significant trends that impact the effectiveness of delivering patient care, critical operational objectives, or other key components within the organization. Ensures that management teams are conducting root cause analyses, as appropriate. Proactively guides management to identify prevention/risk avoidance opportunities and implements continuous improvement plans.

• Monitors and ensures organizational compliance with federal, state and local safety and environmental regulations and standards as well as accreditation requirements. Ensures direct report management monitors and/or revises the departments' safety plan and/or any specific accreditation/regulatory required safety guidelines.

• Proactively approaches the optimization of safe outcomes and information systems by monitoring, improving and enhancing operations, identifying solutions via collaboration. Oversees the implementation of process improvements, utilizing tools such as lean and change management principles. Role models situational awareness, using teachable moments to improve safety.

• Directs the review of provider contracting rates to ensure strategic focus is on target with overall strategy.

• Ensures strong partnerships with Quality teams internally to maximize revenue for quality metric goals and bonuses.

FINANCE ESSENTIAL FUNCTIONS

• Ensures departments' operational and capital budgets align with organization's strategic plan. Uses benchmark data to support performance, costs and return on investment.

• Drives the maximization of efficiency and productivity. Leverages relationships with vendors and partners to obtain contracts that support cost-efficient operations and maintenance.

• Establishes and renews contracts ensuring the most favorable possible terms in alignment with HM strategy.

• Oversees budgeting and forecasting initiatives for department and for strategic planning relative to ensuring profitability from payers for the system. Oversees the reporting, monitoring and trending of individual payer contract performance.

• Ensures the dissemination of managed care financial information to internal finance departments and partners to develop optimal contract tracking and modeling reporting processes.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Develops long-range goals and strategic plans. Deploys data and research to drive cross-business organization prioritization.

• Maintains acute awareness of market and industry trends. Implements innovative solutions for practice or workflow changes to improve system operations. Represents HM at community or professional organization meetings.

• Drives change initiatives, maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusts effectively to work within new work structures, processes, requirements or cultures.

• Initiates and executes succession plans. Conducts conversations with direct report management on their My Development Plan (MDP).

• Stays up to date on industry best practices. Promotes knowledge of managed care by serving within and outside HM as managed care subject matter expert and presents to various audiences (students, practitioners, etc.) on managed care topics and trends.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION

• Master's degree in business management, healthcare management or related field

WORK EXPERIENCE

• Ten years of directly related experience in revenue maximization in healthcare to include leading high-performing teams and seven years in a people management role; may consider current HM employee with six years of people management experience in healthcare