Vice President Managed Care

At Houston Methodist the Vice President Managed Care position is responsible for the development optimization and maintenance of the Houston Methodist (HM) managed care payer contracts the establishment of managed care plan agreements and maintenance of health plan relationships. This position directs all aspects of provider network strategy and leads the process of continuous enhancement of contractual margin opportunities. The Vice President Managed Care position oversees the development negotiation and maintenance of payer relations contracts for reimbursement billed through managed care including hospital physician contracts for commercial Medicare Medicaid all products including but not limited to all acute care services behavioral health ancillary services and international. This position ensures the ongoing analysis of complex statistical cost and financial analysis to improve and optimize operational and financial effectiveness of the managed care payers across Houston Methodist.

This position reports directly to Executive leadership in the organization and has responsibilities which include providing management and oversight of multiple areas and entities as appropriate and driving Houston Methodists mission vision values and commitment to excellence. Demonstrating a proven record of successful strategic planning developing longrange goals and implementation this position manages a diverse interprofessional team collaborating with stakeholders to achieve mutual goals. Directly and indirectly overseeing management staff with the goal of enhancing professional development and personal growth this position forms and leads internal teams providing training and mentorship as needed. This position collaborates with all senior leadership to meet the organizations objectives ensuring operational initiatives are implemented setting business goals and solving internal issues when needed. Responsible for the assigned areas policy and procedure development revision and implementation. This position is also accountable for employee engagement adequate staffing levels budget development and compliance to ensure a safe and effective work environment. This position ensures compliance with ethical and legal business practices and accreditation/regulatory/government regulations.

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental Scope of Service and Provision of Care plans as applicable for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional ethical physical and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth dignity and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET Managing Up Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees experiential journeys to ensure strong communication ease of access to information and a seamless experience

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Actively supports the organizations vision fulfills the mission and abides by the I CARE values

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 ones area and other departments to achieve business goals. Works collaboratively with stakeholders to foster a climate of open communication and mutual problemsolving.

• 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/customerbased 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 organizations 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 costefficient 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 longrange goals and strategic plans. Deploys data and research to drive crossbusiness 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 allinclusive; 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

• Masters 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 highperforming teams and seven years in a people management role; may consider current HM employee with six years of people management experience in healthcare

LICENSES AND CERTIFICATIONS REQUIRED

• N/A

KNOWLEDGE SKILLS AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job determined through ongoing skills competency assessments and performance evaluations

• Sufficient proficiency in speaking reading and writing the English language necessary to perform the essential functions of this job especially about activities impacting patient or employee safety or security

• Strategic vision with the ability to execute

• Demonstrated leadership presence and maturity

• Impeccable judgment and ability to make sound decisions in a fastpaced dynamic setting

• Executivelevel presentation skills and ability to interface successfully with highlevel clients

• Demonstrates the ability to interact with others in a way that gives them confidence in ones intentions and those of the organization

• Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying ones own behavior to accommodate tasks situations and individuals involved

• Demonstrates leadership qualities and critical thinking through selfdirection initiative and effective interpersonal skills and oral/written communication skills

• Ability to identify and understand issues problems and opportunities comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; takes action that is consistent with available facts constraints and probable consequences

• Extensive knowledge of regulatory and accreditation agency requirements that impact department; stays abreast of industry changes

• Demonstrates flexibility and adaptability in the workplace

• Capable of leading teams/facilitating groups building consensus and garnering highest confidence in professionalism and work product by senior leadership

• Ability to work under pressure and balance many competing priorities; highly responsive and solution/action oriented

• Proficiency in spreadsheet word processing and presentation software

• Maintains a positive and supportive attitude and demeanor

• Professional handling of exposure to confidential/sensitive information

• Expert knowledge of managed care and provider network processes

• Expert knowledge of contract modeling and reimbursement methodologies

• Knowledge of healthcare market issues locally and nationally

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ONCALL*
*Note that employees may be required to be oncall during emergencies (ie. DIsaster Severe Weather Events etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area Yes

Houston Methodist (HM) is one of the nations leading health systems and academic medical centers. HM consists of eight hospitals: Houston Methodist Hospital its flagship academic hospital in the heart of the Texas Medical Center and seven community hospitals throughout the greater Houston metropolitan area. HM also includes an academic institute a comprehensive residency program a global business division numerous physician practices and several freestanding emergency rooms and outpatient facilities. Overall HM employs over 25000 employees. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.

In 2019 Houston Methodist and its physicians treat more than 6333 international patients from more than 76 countries. Houston Methodist Global Health Care Services consulting and education divisions also provide advisory services and training and development to health care organizations around the world.