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  • Fort Lauderdale, FL

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AVP Managed Government Program

East Florida Division Office • Fort Lauderdale, FL

Posted 28 days ago

Job Snapshot

Full-Time
Degree - 4 Year Degree
Healthcare - Health Services
Banking, Finance, Government, Management
14

Applicants

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Job Description

One of the nation’s leading providers of healthcare services, HCA is made up of locally managed facilities that include more than 250 hospitals and freestanding surgery centers located in 20 U.S. states and in the United Kingdom.
 
We are committed to delivering healthcare as it should be: patient-centered and for the good of all people, no matter their circumstance. 

JOB SUMMARY
 
 
At the direction of the Regional VP of Managed Government Programs in the Payer Contracting & Alignment department:  Participate in supporting the strategic course for assigned markets to promote maintenance and optimization of the fee-for-service price/volume equation, including seeking opportunities for alternative payment models (APMs) in order to maintain and grow managed government net revenues.  Administer, coordinate and support all negotiation, contracting and reporting activities relative to managed government programs on behalf of the HCA facilities in the markets comprising the AVP’s assigned responsibility portfolio, pursuant to the division or market business/financial plan and PC&A policies and procedures.  Note:  This is a senior level position within the Company, with significant revenue responsibilities and requiring a high-level understanding of healthcare financing and delivery and the ability to think strategically and offer innovative solutions to the complex challenges facing both the Company specifically and the healthcare industry in general (in addition to the ability to successfully manage day-to-day operational responsibilities). 

The PC&A AVP will be officed in East Florida Division, Ft. Lauderdale FL with responsibility for the following markets: Florida and South Carolina  

 
  • The primary responsibility of the AVP is to obtain and maintain contracts with Managed Government Program payors, optimizing the fee-for-service price/volume equation of a net revenue portfolio greater than $.5B but no more than $2.5B, and which includes hospitals, behavioral health facilities, provider-based (free-standing) emergency departments, ambulatory surgery centers and various ancillary provider types, including maintaining connectivity with the Company’s employed physicians (PSG) and other referral alignment vehicles under APMs. 
  • Maintain current knowledge of State and Federal regulations, laws and legislative agendas regarding the healthcare industry, paying particular attention to those involving state Medicaid and managed care, CMS federal programs for FFS Medicare and Medicare Advantage, as well as healthcare reform.  Engage and coordinate with HCA’s internal government relations team and state hospital associations to monitor regulatory and legislative changes, and provide formal guidance on risks and opportunities that may impact the managed government portfolio.
  • The AVP is responsible for providing input on his/her area of expertise in the preparation of the annual Market Strategic Reviews (as applicable) and PC&A budget packet with his/her RVP for each market, at the direction of the PC&A CVP of Managed Government Programs.
  • The AVP will oversee the successful coordination, negotiation and implementation of contracts with Managed Care Organizations (MCOs) operating in the managed government space and maintain effective working relationships with his/her MCO counterparts.
  • The AVP will ensure that all required processes and available strategic pricing, legal, reporting and communication tools will be deployed in order to both (a) maximize contract performance/yield (e.g., Net Revenue, NRAA, Net Revenue relative to traditional Medicare/Medicaid reimbursement, Contribution Margin, etc.), and (b) be consistent with the Division’s contribution margin and/or EBIDTA and pricing objectives.  Among these requirements will be maintaining an effective working relationship with the Analytics & Pricing Services (A&PS) and PC&A Legal department staffs and adeptness with Qlikview, Cash Reconciliation Reports and Service Line tools.
  • The AVP will collaborate and assist with his/her Commercial PC&A and PC&A-Physician Services Group (PSG) colleagues relative to contracting activities with MCOs and other payors, as may be required from time to time.
  • The AVP will monitor Managed Government Program payors’ performance via regular reviews of payor volume, rate and yield, including volume/yield and cash reconciliation reporting on at least a quarterly basis.  The AVP will also be heavily involved in denial management activities, from avoidance (by securing robust contract protections) to information gathering (via regular meetings with Case Management and SSCs and participation in DMAT) to resolution (via JOCs and other problem-solving interfacing with the MCOs) to disputes (via involvement with PC&A Legal, SSC Legal, external counsel and other dispute resolution processes).
  • Supervise, oversee and develop direct reports (if any/as applicable) in accordance with their job descriptions, all Company requirements and the dictates of personnel management best practices.
  • Actively participate as a key member of HCA’s Group/Division/Market operations management team as applicable, and provide input for annual business plans, education on managed government legislative issues and support for annual budgets and other communication strategies for assigned markets.
  • As a key member of the PC&A senior management team, participate in strategic development initiatives as assigned by the RVP or CVP, including but not limited to such things as APMs (e.g., capitation, pay-for-performance (P4P), bundled payments, volume guarantees, etc.), contracting practices (e.g., language standards, protective provisions, etc.) and subject-specific task forces as may be assigned.
  • Comply with standard Company reporting and signatory requirements, including but not limited to timely updating and submitting the Monthly Operating Report (MOR) and various other monthly reports as applicable and assigned (e.g., Major Payor Update, ASC Update, Completed Contracts Report, Behavioral Health Update, etc.), participating in the development and presentation of annual Strategic Market Reviews and Contract Strategy Presentations (CSPs), adhering to Contract Process, Team Room and C-Trax requirements, evaluating and processing APM initiatives, completion and documentation (in HealthStream or in-person attendance) of annual Code of Conduct, Physician Relationship, Information Protection and other required training activities, business/travel expense processes through Concur, human resources policies and procedures (e.g., use of TMS/Authoria system for goal-setting, performance evaluations, etc.), and so on.
  • Ensure that a permanent record of all negotiations and documentation relating to Managed Government Program contracting activities is maintained in local files, electronic files and/or C-Trax (or as may otherwise be permitted/required); provide copies of finalized documents to the SSC and (as applicable) Ambulatory Surgery Division (ASD) and PSG; and provide for administration of completed contracts and amendments through formal in-servicing and other summary documents to PSG, SSC, Case Management and other key stakeholders, in order to enable them to better operationalize such MCO contracts.              
  • Practice and adhere to HCA’s mission and values statement and code of conduct, and attend all required ethics and compliance training and retraining.
  • Perform other duties as may be assigned or requested by the SVP, CVP, RVP, Division CEO and CFO, ASD and hospital leadership.

Job Requirements

EXPERIENCE 

Preferably 10 years of experience 
Managed Care contract negotiation experience, whether for a hospital system or MCO

EDUCATION 


Undergraduate Degree Required. Masters Degree Preferred


SPECIAL QUALIFICATIONS


Managed Care experience, specifically in the areas of negotiation, financial analysis, payment methodologies, and contract language.   
20% travel required. 

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Job ID: 10201-21781
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