The University of Texas Medical Branch VP, Managed Care & Clinical Contracting Strategies in Galveston, Texas

Min Qualifications

Master’s degree in Business or Health Care Administration

Minimum of ten years experience with contract negotiation for hospital and physician services

Minimum of ten years of healthcare financial/managed care supervisory experience, including 5 years in a senior management position.

JOB DESCRIPTION:

Coordinates, evaluates, and oversees implementation of managed care contracting and related operational responsibilities, value-based purchasing initiatives, and partnering opportunities with regional employers. Continuously monitors the competitive environment, understands the trends that affect current and future healthcare business models and reimbursement. Works in conjunction with the Vice President Business Development to assess and maximize managed care relationships in all business development initiatives. Oversees revenue integrity functions in an effort to optimize reimbursement for UTMB. Oversees the institutional contract approval/review function for the organization’s authorized official.

Salary Range

Salary is commensurate with experience.

Specific Job Related Duties

ESSENTIAL JOB FUNCTIONS:

  • In conjunction with the EVP Chief Business and Finance Officer, develops and implements managed care contracting strategy including implementation of value based reimbursement initiatives. Responsible for maintaining reimbursement strategy and all third party negotiations for contract provisions. Oversees and directly manages the following revenue cycle support functions:
  • Development and ongoing maintenance of hospital & physician contract management systems and staff to validate actual payments to expected payments for services.
  • Oversight and maintenance of chargemaster for hospital & professional services. This includes daily addition of new charges in accordance with organizational pricing policies and billing compliance regulations. Annual review of chargemaster to evaluate/identify rate increases for both hospital & physician services and package pricing for combined hospital and physician services.
  • Oversight and management of provider enrollment process for all UTMB providers with external government (Medicare & Medicaid), managed Medicare and Medicaid payors as well as commercial payors.
  • Development, implementation & management of revenue integrity function to include hospital and physician charge capture, ongoing review of revenue and usage, and identification of continued opportunities to capture charges to increase net revenue.
  • Collaborates with the Vice President of Business Development and assists with review and recommendation of enterprise wide business development initiatives. This includes partnerships, joint ventures, acquisitions, and other opportunities to increase the network of facilities and services provided by the organization.
  • Assist with development and implementation of the organization’s Population Health Strategy to include specific responsibility for development and implementation of value based reimbursement initiatives to include pay for performance, bundled payments, shared savings arrangements & ACO participation.
  • Assists with revenue projections and proformas for various lines of business based on existing contracts, payor mix assumptions, and new lines of business.
  • Oversees the institutional contract approval/review function specific to expected business and financial requirements and routinely reviews contract provisions for renewal/termination as required before execution by the organization’s authorized official.
  • Remains abreast of current and emerging issues related to the national, state, and local health care market.
  • Adheres to internal controls and reporting structure.

MARGINAL OR PERIODIC FUNCTIONS:

  • Performs related duties as assigned.

KNOWLEDGE/SKILLS/ABILITIES:

  • Thorough knowledge of commercial managed care, Medicaid, and Medicare contract payment terms, healthcare finance concepts and principles.
  • Understanding of future reimbursement trends and directly related experience in risk contracting for hospital and physician services.
  • Thorough knowledge of bundle, at risk and global payments.
  • Excellent analytical and problem solving skills; exceptional verbal and written communication including negotiation and presentation skills.
  • In depth knowledge of hospital and professional coding and reimbursement methodologies. (i.e. DRG, APC, APG, CPT, RVU, conversion factors).
  • Knowledge of federal, state, and local regulations, guidelines, and standards in area of expertise.
  • Ability to lead effective teams and to build and maintain strong business relationships with internal and external clients.
  • Decisive, effective leadership skills
  • Ability to provide responsive customer service and follow through.

Closing Statement

#exec

Equal Employment Opportunity UTMB Health strives to provide equal opportunity employment without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or veteran status. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.

Full/Part Time: Full-Time

Job Type: Regular

Job Title: VP, Managed Care & Clinical Contracting Strategies

Job ID: 60503

Location: Galveston

Business Unit: FINCE