SWHRCIN VP Managed Care SWHR

Southwestern Health Resources was established in April 2016 as a unique partnership between the founding entities, UT Southwestern Medical Center, a public academic medical center, and Texas Health Resources, a private faith-based non-profit health system, based on a shared commitment to create a highly differentiated value proposition in both quality and total cost of care for consumers, purchasers, patients and physicians. A cornerstone of Southwestern Health Resources is a clinically integrated network of independent and employed physicians, including the employed faculty physicians of UT Southwestern, the employed physicians of Texas Health Physician Group, and independent community primary care and specialty care physicians. The integrated network builds on more than 50 years of collaboration between the two institutions to improve the health of North Texans.

Southwestern Health Resources includes 29 hospital locations and more than 5,000 physicians located throughout North Texas in its network. With over 650 points of access to care, this provides for higher value and allows patients to access services across a full continuum of medical needs. The network serves people across 16 counties in North Texas. SWHR coordinates care for more than 700,000 patients, aligned with commercial health care plans and Medicare programs, along with more than 13,000 Medicare beneficiaries enrolled in its Care N' Care health plan. It also provides Population Health Services through clinical and quality data along with analytic services necessary to support the physician-driven clinical decisions.

Position Summary: The VP Managed Care SWHR is responsible for developing strategies for growing and maintaining the managed care portfolios associated with Southwestern Health Resources.

Responsibilities and Duties: • Leading the negotiation and implementation of managed care contracts with health insurance payers, ensuring favorable reimbursement rates and network access terms.

• Creating and maintaining relationships between operations, clients, and payers related to contract performance.

• Provides executive oversight for contracting strategy and market evaluation.

• Leads in the development and implementation of innovative solutions and products that drive value for the Clinically Integrated Network and its participants.

• Develop and Support strategic contracting strategies for employers working with the business development team under the Chief Market, Payor Relations and Financial Officer of SWHR.

• Creating and maintaining strong client and key internal relationships that facilitate the monitoring of payer issues such as provider participation, contract loading, and payment issues.

• Preparing reports and presentations to monitor portfolio performance, yield, payer enrollment, payer mix, etc.

• Assisting in the development of organizational goals, guiding teams to executing projects to achieve these goals, and working closely with others within the organization to continuously monitor department performance.

• Proactively anticipates and makes recommendations to resolve key operational and functional gaps that would prevent the successful implementation of payer arrangements and network strategies.

• Provides executive oversight for managed care and ACO operations, including payer joint operating committees and associated operating meetings with health system partners.

Professional Experience/Qualifications: Individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individual with disabilities to perform the essential functions. This role requires the ability to solve problems, think outside-the-box, and be resourceful; must be result-oriented, a quick learner and self-starter. Comfortable working in complex and matrix organizations. The requirements listed below are representative of the knowledge, skill, and/or ability required to build SWHR's culture for action.

• Bachelor's degree in related field required.
• Master's degree in related field preferred.
• 8 years management experience in complex health systems managed care and provider network operations.
• Progressive experience in value development for providers and facilities through design and implementation of complex payer reimbursement methodologies.
• Exceptional Customer Service / Client Retention skills, ability to communicate with senior C-suite leaders of large physician groups and hospital / health systems.
• Excellent leadership and communication skills to effectively manage internal and external stakeholders
• Deep understanding of the healthcare industry, including managed care regulations and reimbursement methodologies
• Skilled negotiator with a proven track record and able to achieve results in challenging environments, including direct experience within contract negotiations and complex reimbursement arrangements including but not limited to value-based arrangements, capitation, fee-for-service, bundled payments, carve-outs, DRG's, etc.
• Develop and maintain a deep understanding of state and federal legislation related to payment initiatives and policy changes
• Excellent written and oral communication skills, confident and impactful presenter - experience leading meetings with senior leadership of large organizations
• Ability to work in a matrix environment where multiple and competing customer demands are likely.
• Self-directed with a strong bias for action.
• Demonstrated building and leading successful teams in a managed care setting.