Vice President Managed Care

HARTZ Search
Published
March 3, 2022
Location
Fort Worth, Texas
Category
Default  
Job Type
Active  

Description

VICE PRESIDENT, MANAGED CARE & HEALTH PLAN PROGRAMS

JPS HEALTH NETWORK

FORT WORTH, TEXAS

HARTZ Search invites you to explore an exciting opportunity with our client, JPS HEALTH NETWORK in Fort Worth, Texas, for a Vice President, Managed Care & Health Plan Programs.  The VP, Managed Care & Health Plan Operations is responsible for the successful operation of JPS Connection programs and driving growth across the organization, financial and service excellence, and continued improvements in clinical quality and patient outcomes with a focus on lowering the cost of care for residents of Tarrant County. Under the leadership of the COO, this role provides operational leadership and strategic and tactical oversight over the Health Plan Administration functions for the JPS Connection programs in alignment with JPS Health Network’s overall mission, vision and strategic plan.

The VP, Managed Care will be responsible for the strategy, operations and driving financial results of JPS managed care & health plan functions. The position coordinates, evaluates, and oversees implementation of managed care contracting and related operational responsibilities, value-based contracting initiatives, selected government/county contracts and partnering opportunities with regional employers. The new leader continuously monitors the competitive environment, and trends that affect current and future healthcare business models and reimbursement. The VP collaborates with business development team in areas that managed care impacts organizational strategic initiatives. The new leader oversees revenue integrity, provider enrollment and charge master operations, and the institutional contract approval/review function for the organization’s authorized official, while maximizing operational standards related to third party payment and facilitates enhanced access to the organization for members of the community.

This role integrates and aligns payer strategy with JPS/ JPS Connection strategic objectives, including population health strategies, value-based contracting strategies, contract management, operations processes, and government reimbursement trends. Includes integration (relative to payer strategy) across key JPS/ JPS Connection functional areas of Revenue Cycle Management, Finance, Reimbursement, Legal, Business Development, and Health Plan Operations.

 

ESSENTIAL DUTIES/ FUNCTIONS FOR THE ROLE:

  • Responsible for the strategic and tactical oversight of the JPS Connection health plan administration.
  • Lead the planning and development, as well as monitor the deployment of, strategic initiatives within the JPS Connection programs to advance the mission of the organization.
  • Establish and execute a strategy for health plan operations that leads to long-term operational efficiency and scalability.
  • Assess and build out the managed care team and supporting infrastructure to appropriately serve stakeholders with support and delivery of analytic and operational resources and services to enable success in a value-based environment.
  • Develop a data rich approach to decision making, by developing an analytics function to support contracting, negotiations, heat maps, market share and covered lives
  • Must be able to analyze data, identify trends, draw conclusions, and determine solutions for both enrolling and managing members across multiple programs and geographies.
  • Lead, manage and oversee operational management infrastructure, and standard performance reporting.
  • Providing leadership for our Payer contracting efforts to build upon our external relationships with Commercial and Government payers in order to maximize our reimbursement opportunities.
  • Building programs and providing leadership through JPS Connection as the external face of the organization for our Employer and Community customers in order to improve the health and well-being of an employee population, manage total cost of care, increase appropriate utilization of system services while increasing market share and positioning JPS Health Network/ JPS Connection as the system of choice for Tarrant County.
  • Providing executive leadership and developing strategic relationships with key partners like Acclaim, and JPS Connection in order to introduce new products in the market while positioning JPS Health Network to increase volumes and revenue.
  • Identify and evaluate new market opportunities that lead to growth potential for JPS Health Network and our physician partners.
  • Must understand technology platforms and stakeholder needs and be able to prioritize development roadmaps.
  • Oversee and provide leadership of the development, implementation and ongoing measurement of programs and special projects (i.e. JPS Connection Retention project) to drive high performance of the JPS Connection programs.
  • Develop an operational playbook for JPS Connection programs including best practices for enrollment, billing and other key functional areas with unique requirements.
  • Development and ongoing maintenance of hospital & physician contract management systems and staff to validate actual payments to expected payments for services.
  • Serves as the Senior Plan leader and liaison for network service operations, including: Claims, Information Management, Eligibility & Enrollment, Contact Center Operations, IT, Medical Services Reimbursement, and other departments as required. These network shared services operations that support the Health Plan will have dotted line responsibility and accountability to this position.
  • Manages the Plan's benefit configuration, claim payment policies and the maintenance or modification of such, to support accurate and timely claims payment.
  • This role requires the identification and adoption of best practices from across the enterprise for Health Plan Operations.
  • Partner with senior leaders in the organization to drive cross-departmental efficiency and continuous process improvement.
  • Collaborates with business development team, Office of Strategy Mgmt, Innovation/ Transformation, and Acclaim 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.
  • Project planning, implementation and delivery of JPS Connection related activities in coordination with other departments.
  • Experience successfully partnering with providers and care teams in a patient and provider-centric manner to effect change and improve processes and outcomes.
  • Works with staff and senior management to develop and implement improvements and oversight for non-clinical Health Plan operations.
  • Operationalize innovative benefits, programs, networks, provider contracts, and medical cost-reduction strategies.
  • Execute multiple medical cost-reduction strategies.
  • Comfortable leading large-scale transformation and change management initiatives.
  • Accountable for developing and ensuring Health Plan Operating metrics consistently meet and/or exceed all compliance requirements as well as key performance targets and associated service level agreements.
  • Use Voice of the Customer operational data to evaluate and improve the JPS Connection programs.

 

JPS Health Network is a $950 million, tax-supported health care system for Tarrant County in North Texas.  This award winning network is anchored by John Peter Smith Hospital, which is a 573-bed acute care in Fort Worth, Texas. JPS has the only Level 1 Trauma Center in Tarrant County and the county’s only psychiatric emergency services site. JPS is also a certified Chest Pain Center, Certified Primary Stroke Center and an Accredited American College of Surgery Cancer Center. JPS has a Level lll Neonatal Intensive Care Center (NICU).  JPS Health Network received the Modern Healthcare Best Places to Work 2017 designation placing JPS among the top 150 healthcare companies in the nation. JPS is the only public entity in Texas included on the list of 2017 Best Places to Work, one of the most coveted honors in the industry.

 

POSITION DETAILS & REQUIREMENTS:

  • The position reports to the Senior Executive Vice President/ Chief Operating Officer.
  • New VP, Managed Care will be responsible for building out the managed care function for the JPS Health Network
  • Master’s Degree in Business Administration, Healthcare Administration, Finance, marketing or related field.
  • EPIC EMR experience preferred
  • Hospital, Healthcare, and Health System experience required with experience in development and implementation of Health Plans, Payor relations and Managed Care strategies
  • 8+ years of progressive management leadership experience
  • Broad knowledge of health insurance and services delivery and functions.
  • Implementation and understanding of analytics to support decision making in managed care
  • Competitive Compensation, Annual Incentive plan, and excellent benefits

 

LOCATION – FORT WORTH, TEXAS:

Fort Worth is the 11th-largest city in the United States and part of the No. 1 tourist destination in Texas, welcoming more than 9.1 million visitors annually. Comprised of eight primary entertainment districts, each distinct offering dining, shopping, entertainment, and cultural amenities. In only a few days, you can enjoy a range of experiences: from NASCAR racing to rodeos, world-class museums to cowboy cuisine, boutique shopping to a Top 5 zoo, biking to horseback riding.   Fort Worth offers outstanding education, both public and private, affordable housing options, and you are less than 20 miles from one of the world’s largest airports with direct flights all over the world.

 

INTERESTED CANDIDATES, PLEASE APPLY DIRECTLY to HARTZ Search below:

Qualified candidates, please submit your current resume - applications will not be considered without a resume. Thank you!

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