Vice President, Managed Care & Health Plan Integration (On-Site)
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Job Location:
Fairfield, OH - USA
Monthly Salary:
$ 300 - 375
Posted on:
22 hours ago
Vacancies:
1 Vacancy
Job Summary
**** This position is being managed by Witt/Keifer please contact JenniferSonneland ****
At NorthBay Health we are a rapidly expanding physician-guided integrated health system operating across multiple counties with multiple hospitals 300 employed/providers-aligned physicians and significant ownership in a successful growth-oriented regional health insurance plan. The health plan is a strategic differentiator that drives alignment value-based performance and margin.
SUMMARY
This is an executive role responsible for accelerating the profitable growth of our owned health plan deepening payer relationships and embedding the health system and health plan into the fabric of every community we serve.
This is a highly visible enterprise-wide leadership position that combines traditional managed care contracting expertise with modern population-health strategy product design marketing and community partnership development. This is a rare opportunity for a strategic growth-oriented managed care executive to take a visible role in building one of the fastest-growing integrated health system/health plan combinations in the country.
KEY RESPONSIBILITIES
- Health Plan Growth & Profitability
- Lead/support membership growth strategy targeting commercial Medicare MediCal/Partnership lines of business (goal: align with ANS growth strategy targets).
- Oversee product design pricing network strategy and benefit configuration in collaboration with actuarial clinical and sales teams.
- Achieve and exceed annual medical loss ratio (MLR) administrative expense and margin targets.
- Managed Care Contracting & Payer Strategy
- Negotiate and manage all external payer contracts (national regional and local plans) to maximize system reimbursement while protecting health plan competitiveness.
- Serve as the enterprise expert on value-based contracting bundled payments and risk arrangements.
- Community Awareness Brand Integration & Market Expansion
- Develop and execute a comprehensive community engagement and brand-integration strategy in conjunction with the Marketing Communication Team so that the health system and health plan are recognized as the preferred local choice in every new and existing market.
- Build strategic partnerships with large employers chambers of commerce school systems FQHCs faith-based organizations and municipal governments.
- Lead employer direct-to-employer (DTE) sales and narrow-network product launches.
- Clinical & Financial Integration
- Partner with Population Health clinical leadership and medical group presidents to hardwire clinical programs (chronic disease management transitional care behavioral health integration) that simultaneously improve health plan STAR/HEDIS performance and reduce system total cost of care.
- Drive shared savings and risk-revenue performance across Medicare ACOs MSSP and commercial risk contracts.
- Leadership & Team Development
- Build and lead a lean high-performing team (contracting network development provider relations community engagement health plan sales/support).
- Serve as a key member of the system leadership team and prepare regular updates for the system board of directors.
Qualifications
- Education: Bachelors degree required; Masters (MHA MBA MPH) strongly preferred.
- Experience: Ten to fifteen (1015) years progressive managed care leadership experience within a health system health plan or large medical group. Proven track record of growing a health insurance plan or major product line (membership and profitability). Deep expertise in value-based care contracting payer negotiations and risk arrangement design. Demonstrated success in employer sales community partnership development and brand-building in competitive markets. Experience with Medicare Advantage Medicaid managed care and commercial products. Current or prior P&L responsibility for a health plan or major business unit preferred. Experience launching narrow-network or direct-to-employer products preferred. Existing relationships with national and regional payers in our footprint preferred.
- Skills: Exceptional communication skills with experience presenting to boards large employers and community stakeholders.
- Interpersonal Skills:Demonstrates the True North values. The True North values are a set of value-based behaviorsthat are to be consistently demonstrated and role modeled by all employees that work at NorthBay Health. The True North values principles consist of Nurture/Care Own It Respect Relationships Build Trust and Hardwire Excellence.
- Hours/ Work Specification: A successful leader will live and serve in the geographic area of NorthBay Health. Full time management exempt. Hours will vary according to work demands.Willingness to travel 3040% across current and expansion markets. Primary work location is corporate headquarters in Fairfield
- Compensation: $300-375k fixed base rate addition This position is eligible for the variable compensation incentive.
Required Experience:
Exec
Key Skills
- Change Management
- Financial Services
- Growing Experience
- Managed Care
- Management Experience
- Analysis Skills
- Senior Leadership
- Performance Management
- Process Management
- Leadership Experience
- negotiation
- Analytics
About Company
At NorthBay Health, we are guided by our values: Nurturing Care; Own It; Respect; Build Trust; and Hardwire Excellence. These principles lead us to our TRUE NORTH and inspire us to provide exceptional care. These values serve as the foundation of everything we do, guiding us to delive ... View more
