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Vice President, Managed Care Georgia Region

Date Posted: Feb 10, 2021
Charlotte, NC, United States
Job ID: 1257
Shift: Day
Department Name: 51011028342302-Human Resources Talent Acquisition and Workforce Admininstration
Location: Atrium Corporate Operations

Overview

Division Overview:
In 2019, Atrium Health combined with Navicent Health to bring patients in Macon, GA more quality healthcare. Navicent Health, a part of Atrium Health, was incorporated on Nov. 17, 1994, as a nonprofit corporation whose purpose is to coordinate The Medical Center, Navicent Health and other affiliated entities toward our mission: “Together, we elevate health and well-being through compassionate care.” Today, Navicent Health has more than 1,000 licensed beds for medical, surgical, rehabilitation and hospice purposes, offers over 53 specialties in more than 30 locations and hosts over 100 medical residents and fellows. Included within the Navicent Health system is The Medical Center, Navicent Health, a 637- bed, American College of Surgeons nationally verified Level I Trauma Center and a three-time Magnet- designated hospital for nursing excellence worldwide.
Distinguished nationally for its excellence, Navicent Health is also one of the premier teaching hospitals in the United States and serves as the primary teaching hospital for the Mercer University School of Medicine. Navicent Health supports residency-training programs in family medicine, general surgery, internal medicine, obstetrics and gynecology, and pediatrics along with fellowships in surgical critical care, geriatrics, hospice and palliative medicine, and infectious disease. Navicent Health also partners with a number of central Georgia universities and colleges to offer advanced training for nursing students. As a teaching hospital, Navicent Health attracts the best and the brightest to the area.


Position Summary:
Reporting to the SVP, Managed Care and working closely with population health leadership, clinical leadership, and other key stakeholders, the VP, Managed Care Georgia Region will be a critical thought-partner responsible for developing a Georgia region payor strategy that is aligned with Atrium Health’s organizational goals and enables the health system to succeed in a dynamic reimbursement environment. The VP, Managed Care Georgia Region 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 VP, Managed Care Georgia Region will be responsible for creating and leading a strategy across the region and any future GA 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 VP, Managed Care will oversee negotiations with commercial plans and maintain relationships with these plans in order to achieve region’s strategic, operational and revenue objectives. The VP, Managed Care will oversee the assessment of government programs and initiatives, voluntary and mandated, including Managed Medicaid, to measure the financial impact to the Georgia region and alignment with the system-wide strategy.


Key Responsibilities:

  •      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 GA region
  •      In partnership with clinically integrated network and population health leadership, advance organizations’ value-based payment strategy through the optimization of existing programs and development of new risk-based reimbursement models and innovative insurance products featuring providers
  •      Collaborate with clinical leaders to develop quality-based metrics and contractual incentives
  •      Lead the regional 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 regional Managed Care team across the Georgia region. 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 and maintaining the region’s largest and most complex commercial contracts
  •      Oversee group responsible for analytics, contract management/modeling, and assessment of new payment methodologies
  •      Own and manage regional 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

Qualifications:

Education:

  •      Bachelor’s degree required (Master’s preferred) in business, health care administration, finance, marketing or related fields

Work Experience:

  •      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
     

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 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 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 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 Atrium’s culture.