Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery and patient care, Vanderbilt University Medical Center (VUMC) is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded and your abilities challenged. It is a place where your diversity â of culture, thinking, learning and leading â is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. VUMCâs mission is to advance health and wellness through preeminent programs in patient care, education, and research.
VUMC is conducting a national search for a Managed Care Leader to provide services to its subsidiary, the Vanderbilt Health Affiliated Network (VHAN), a collaborative partnership of physicians, health systems, and employers driving a new level of clinical innovation and teamwork to enhance patient care, contain costs, and improve the health of our communities, announces.
Reporting directly to the Executive Director of VHAN, the selected Managed Care Leader plays an important role in coordinating the design, development, deployment and execution of payer contracts with insurers, third-party administrators and self-insured employers in partnership with VHAN participants. The Managed Care Leader is also accountable to the VHAN Board of Directors and the VHAN Contract Management Committee, a Board-appointed committee. The Managed Care Leader, in concert with the Contract Management Committee, will oversee and facilitate the design of VHANâs managed care contracting strategy, to evolve from value-based payer contracts to coterminous, full fee-for-service and value-based contracts that reward provider performance. The Leader is responsible for implementing the VHAN contracting strategy with payers, including self-insured employers, and VHAN participants, consistent with the principles, policies and procedures adopted by the VHAN Contract Management Committee. In this role, the Leader identifies payer-driven and member-specific net revenue, volume and cost trends and targets by market, and collaborates with VHAN participants to negotiate contracts that contribute to achieving annual growth targets.
VUMC is seeking a dynamic and accomplished healthcare and managed care leader who can work effectively in a relationship-driven culture. The chosen executive must be a strategically minded visionary leader and collaborative team player who knows how to effectively drive managed care strategy in a complex environment, embodying the VHAN mission and providing leadership through respect, collaboration, and adherence to process. This role is integral to the creation and delivery of value to VHANâs participants, and, thus, why a seasoned, savvy strategist is needed.
About Vanderbilt Health Affiliated Network
The Vanderbilt Health Affiliated Network (VHAN) is transforming the way healthcare is delivered across Tennessee and the surrounding states. In 2012, a group of the regionâs top physicians, hospitals, and health systems came together to envision a new way of delivering healthcare. The founding vision was focused on preserving health, sharing knowledge, and investing in communities.
Today VHAN is focused on leading the transformation of health care delivery across the Mid-South by activating a high-performing alliance of like-minded health care providers and creating innovative solutions to improve health and increase value to patients, providers, and purchasers.
Specific background/experiences and skills/accomplishments, which appear to be the most important for success in this role.
Career track of accomplishments with successful experience earned in increasingly progressive leadership roles within a large, complex, multi-location patient care environment. Demonstrated record as a recognized leader in managed care activities and processes, and master of the subject matter.
Superior technical skills in provider contracting strategy, traditional and value-based reimbursement methodologies.
Broad business skills, including analysis of strategic alternatives, financial impact analysis and product and network development.
Substantial experience in managing complex and high-profile payer/provider negotiations independently, with multiple stakeholders.
Understanding of regulatory and compliance requirements related to contracting and ability to ensure that contract language complies with with all state and federal regulatory and NCQA standards.
Track record of successful Board and committee presentations and facilitation.
Must have a strong track record in negotiating hospital and physician fee-for-service and value-based managed care contracts, as well as experience in contract analytics, healthcare pricing, network management and risk contracts and global risk management.
Solid knowledge of, and expertise to oversee, financial and decision support analytics and contract modeling.
Strong hospital, physician and payer relationship skills are required.
Proven negotiation skills, contract language review skills, marketing and financial effectiveness are required.
Solid understanding of Medicare, Medicare Advantage and Medicaid managed care programs required.
Solid knowledge of actuarial functions related to developing capitated and risk contract rates preferred.
Proven ability to oversee managed care staff to support managed care contract operations, which include negotiation planning, negotiation sessions, and monitoring the contractsâ actual results vs. targets so that the VHAN participants are aware of their performance on an ongoing basis.
Skill to oversee the creation and execution of contractual language and terms in coordination with the VHAN Contract Management Committee to support VHANâs and its participantsâ goals around quality improvement, profitable growth and cost savings.
Collaborate with VHAN participants, including conducting regular contract performance updates with contracting leaders from those organizations.
Ability to negotiate and/or supervise a team of contractors to develop and negotiate contract terms using VHAN language standards developed by the Contract Management Committee.
Skill to prepare quarterly updates and recommendations for presentation to VHAN leadership, the Contract Management Committee, and the VHAN Board regarding market-based managed care opportunities.
Experience and expertise to serve as an expert go-to person for VHAN staff and VHAN participants, to ensure best practices in negotiations to achieve targets and to coach colleagues on technical matters.
Skill to collaborate with contracting leaders at VHAN member organizations, including conducting regular contract performance updates.
Ability to work in collaboration with VHAN finance department to review contract audits generated by finance to assure accurate contractual reimbursement is received from payers for each market.
Works in conjunction with VHAN Strategic Planning and Business Development to design regional product & network strategies that the Managed Care Leader integrates into payer-specific plans that the Managed Care Leader is accountable to negotiate with payers and employers.
Ability to work closely with the VUMC Office of Legal Affairs (OLA), Compliance, and Government Relations departments, to make sure VHAN and its parent company are compliant in all contracts, and notifies OLA, Compliance and Government Relations if/when issues arise.
Along with other functional leads at VHAN, recommends which providers should be added/removed from the VHAN network, based on provider performance, in order to deliver a competitive network to payers and employers.
Skill to collaborate with clinical operations leaders to provide the VHAN IT/analytics department with report specifications so IT/analytics can generate the reports for use by the clinical operational units/practices and managed care functions to optimize contract revenue, inclusive of traditional fee-for-service rate benchmarks, care coordination and network access fee benchmarks and shared savings benchmarks.
Consults with clinical & operational departments to help the clinical & operational departments define the clinical and operating metrics that the managed care team will negotiate with payers.
Collaborates with and relies upon VHAN clinical and operations leaders to improve clinical delivery and logistics to achieve the process and outcome metrics the contracting team negotiates with payers.
Bachelor's Degree, preferably in Business Administration or Health Administration, is required. Master's Degree or equivalent experience is preferred. A minimum of seven plus yearsâ experience in managed care contract negotiations, including 2 years of payment for quality, performance and/or capitated hospital/physician contract negotiations. A minimum of 5 plus years of supervisory experience is also required.
Vanderbilt University Medical Center is a comprehensive health care facility dedicated to patient care, research, and biomedical education. Our reputation for excellence in these areas has made us a major center for patient referrals from throughout the Mid-South. Each year, people throughout Tennessee and the Southeast choose Vanderbilt University Medical Center for their health care because of o...ur leadership in medical science and our dedication to treating patients with dignity and compassion.The mission of Vanderbilt University Medical Center is to advance health and wellness through preeminent programs in patient care, education, and research.