Reporting to the EVP, Chief Financial Officer and working closely with population health leadership, clinical leadership, and other key stakeholders, the SVP, Managed Care will be a critical thought-partner responsible for developing an enterprise payor strategy that is aligned with Atrium, Navicent, and Wake Forest Baptist Health’s organizational goals and enables the health system to succeed in a dynamic reimbursement environment. The SVP, Managed Care will bring substantive health plan or managed care contracting experience with a functional skill set in provider contracting, network development or related systems.
S/he will possess a keen understanding of managed care contracting and related initiatives, as well as the underlying systems that support those initiatives. Further, the successful candidate must have a thorough knowledge of risk based contracting and be able to influence operations both within and external to his/her respective organization.
The SVP, Managed Care will be responsible for creating and leading an enterprise strategy across Atrium Health, Navicent Health, Wake Forest Baptist Health, and any future strategic combinations. This progressive strategy will optimize revenue while assessing value-based payment methods, evaluating new market offerings such as limited and tiered network products and considering new market opportunities like telehealth and national and international purchasers. S/he will have responsibility for implementing the strategy through arrangements with both commercial payors and public payors. The SVP, Managed Care will oversee negotiations with commercial plans and maintain relationships with these plans in order to achieve Atrium Health’s strategic, operational and revenue objectives. The SVP, Managed Care will oversee the assessment of government programs and initiatives, voluntary and mandated, including Managed Medicaid, to measure the financial impact to Atrium, Navicent, and Wake Forest Baptist Health and alignment with the system-wide strategy.
- Partner with senior leadership to devise multi-market payor strategies that align with new delivery system requirements and organizational goals while optimizing reimbursement across the enterprise
- In partnership with clinically integrated network and population health leadership, advance health systems' value-based payment strategy through the optimization of existing programs and development of new risk-based reimbursement models and innovative insurance products featuring Atrium Health’s providers
- Collaborate with clinical leaders to develop quality-based metrics and contractual incentives
- Lead the enterprise strategy for preferred payor relationships and identify opportunities for jointly owned and funded products
- Build and maintain relationships with senior network management and contracting leaders at health plans
- Manage and retain an engaged and collaborative department approximately 100 staff members on Managed Care teams across strategic combination partners Atrium Health, Navicent Health, and Wake Forest Baptist Heath. These areas include payor contracting, managed health resources operations, and value-based contract operations; ensure ability to respond to changing needs of the organization and continuously improve effectiveness and efficiency
- Direct responsibility for negotiating health systems' largest and most complex commercial contracts
- Oversee group responsible for analytics, contract management/modeling, and assessment of new payment methodologies
- Own and manage enterprise Managed Care budget and revenue management/growth
- Ensure accuracy, efficiency, and analytic sophistication within the managed care department in alignment with organization-wide analytic efforts
- Bachelor’s degree required (Master’s preferred) in business, health care administration, finance, marketing or related fields
- Minimum of ten years of progressively responsible care delivery or health plan experience in a complex healthcare environment (ideally, multi-state)
- Dynamic and strategic leader; ability to build strong rapport both internally and externally and bring a “win-win” partnership approach to payor negotiations
- Possesses understanding of emerging trends in value-based contracting and payment innovation, such as physician compensation redesign, patient-centered medical homes, bundled payments, and commercial, federal and state ACO programs; takes a thoughtful and pragmatic approach to migrating to at-risk models
- Analytically minded leader with depth of experience in contract modeling and assessing financial implications of new contracting structures
- Specific experience and strong track record in developing strategy to address market issues in healthcare including via payor arrangements
- Experience conducting significant negotiations
- Ability to think critically, understand complex concepts and quantitative analyses, synthesize information and make good judgments
- Excellent oral, written, and interpersonal communication and persuasion skills required
- Ability to lead, work as a team member and manage in a matrixed environment
Critical Success Factors:
- Within 6 months, organize enterprise Managed Care coverage across all regional markets, develop relationships with key internal/external stakeholders, and align team’s talent to optimize Managed Care team’s performance.
- Within 12 months, solidify year-to-year contract increases to maximize revenue and cover inflation. Also, develop a strategy to orchestrate contract renewals.
- Within 2 years, execute and continuously enhance strategy to keep Atrium Health ahead of the ever-changing Managed Care policy landscape.
Enterprise Leadership Imperatives:
Thinks Critically and Strategically
- Recognizes the strategic issues facing their areas of responsibility and Atrium Health as a whole.
- Engages in rigorous problem definition, data collection, and analysis, then makes well-informed decisions in a timely manner.
- Connects the dots in complex business situations and distills their essence into actionable insights.
- Sees the big picture and has a long-term perspective, while balancing it against short-term realities.
- Identifies potential scenarios, assesses risks and ways to mitigate them, and charts the best path forward.
Envisions and Enacts the Future
- Creates a compelling vision of an achievable future.
- Communicates simply and powerfully why change is necessary.
- Mobilizes people and organizational resources to realize their vision.
- Catalyzes innovation and builds adaptive capabilities.
- Is a committed steward of the Atrium Health culture.
Connects and Collaborates Across and Beyond Atrium, Navicent, and Wake Forest Baptist Health
- Recognizes the critical importance of integration and collaboration in achieving high performance.
- Convenes and nurtures cross-system teams, and works effectively in the “white spaces.”
- Seeks win-win outcomes and puts the well-being of the patient and the overall organization first.
- Leads effectively across cultures.
Builds and Leads Inclusive, High-performing Leadership Teams
- Understands the value of diversity in teams and seeks to get the best out of all people.
- Gets the right people in the right roles, then aligns and energizes them to achieve excellence.
- Establishes trust and creates a culture of psychological safety to enable candid debate.
- Builds consensus; decides when necessary.
- Delivers outstanding results through others.
Understands and Shapes the External Environment
- Is deeply knowledgeable about patient needs, the Atrium, Navicent, and Wake Forest Baptist Health business model, and the competitive, political and social environments in which the organization operates.
- Understands the importance of actively engaging with and shaping these environments.
- Identifies, assesses and builds relationships with key stakeholders.
- Is proactive in identifying potential threats and opportunities and adapts rapidly in the face of changing circumstances.
- Mobilizes and directs supporting capabilities in public affairs, communications and government relations to achieve desired outcomes.
Builds Talent for and Across the System
- Demonstrates personal accountability for developing future generations of Atrium, Navicent, and Wake Forest Baptist Health leaders who reflect the diversity of the communities we serve.
- Engages actively with colleagues in assessing and developing executive talent, focusing both on competencies and character.
- Identifies future skillset needs, then recruits and develops people to meet those needs.
- Invests time in coaching and mentoring high-potentials for success.
- Is a role model, embodying the best of our culture.