UNC Health Care System Chief Managed Care Executive Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. This position serves as the Health Care System's chief managed care executive and is responsible for payer strategy including development, analysis, and negotiation of local and national strategic payer relationships, as well as value-based contracting efforts across the system. All payer relationships that require contracting across our system are in the scope of responsibility for the position including commercial, managed governmental contracts (MA, MC) pharmaceutical, and direct to employer. Key areas of focus include assessment, negotiation, implementation, and management of: commercial fee-for-service and value-based managed care payer contracts; Medicare Advantage and Managed Medicaid managed care fee-for-service and value-based payer contracts; narrow network public and private exchange payer contracts; direct to employer; military (Tricare, VA) contracts; specialty and carve-out payer contracts, and other partnership opportunities with payers as required. The System Vice President of Managed Care will optimize the organization's contract performance with its contracted payers so as to maximize the organization's financial viability while also advancing the system's population health and value-based payment model strategy. This position reports directly to the health care system Chief Revenue Officer within the Finance Division.
Responsibilities: Care and Quality Integrative Leadership
- Leads the development and implementation of System-wide Managed Care strategy, through engaging with key stakeholders – internal, external and across the university as necessary.
- Provides day to day leadership and operations management of the Managed Care staff.
- Assures an integrative and collaborative relationship with the UNC Health Alliance and Managed entities across executing Statewide strategy in managed care and alternative payment models.
- Coordinates with UNC Health Alliance, UNC Quality Department, UNC Pharmacy, UNC Research and School of Medicine and care delivery teams to assure payer cooperation, alignment on incentive goals, and accountability for performance.
- Coordinates with owned and managed entities and other areas across the health care system including all hospital, physician and ancillary functions including joint ventures.
- Serves as a member of and key advisor to the UNC NC Health employee self-funded health plan and serves as a member of the reporting/steering committee.
- Serves as the lead negotiator with external payers (e.g. national/regional insurance carriers) on behalf of the organizations owned and managed hospitals, professional groups, and ancillary business units including joint ventures such as ambulatory surgery centers.
- Contributes to strategy development and negotiations with self-funded employer groups in support of the System's direct-to-employer relationship-development function.
- Manages staff and operating budget for all functional departments. Leading People
- Leads people toward meeting the organization's vision, mission, and goals.
- Fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts.
- Encourages workforce engagement by building a commitment to excellence and by promoting the organization's vision internally and externally.
- Delegates' responsibility clarifies expectations and holds others accountable for achieving results related to their area of responsibility.
- Leads in a deliberate and predictable way and operates with transparency.
- Treats sensitive or confidential information appropriately.
- Develops the ability of others to perform and contribute to the organization by providing ongoing feedback and by providing opportunities to learn through formal and informal methods.
- Leads managed care analytics for contract modeling and special projects as needed.
- Leads provider enrollment for delegated credentialing for the health care system
- Manages and resolves conflicts and disagreements in a constructive manner. Leading Change
- Acts as a catalyst for organizational change. Influences others to translate vision into action.
- Brings about strategic change, both within and outside the organization, to meet organizational goals.
- Establishes an organizational vision and implements it in a continuously changing environment.
- Is open to change and new information and rapidly adapts to new information, changing conditions, or unexpected obstacles.
- Deals effectively with pressure and remains optimistic and persistent, even under adversity.
- Recovers quickly from setbacks.
- Formulates objectives and priorities, and implements plans consistent with the long-term interests of the organization.
- Capitalizes on opportunities and manages risks.
- Takes a long-term view and builds a shared vision with others. Results Driven
- Exceeds organizational goals and customer expectations.
- Makes decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks.
- Holds self and others accountable for measurable high-quality, timely, and cost-effective results.
- Partners with revenue cycle operating leaders to reduce denials through active payer engagement and accountability.
- Collaborates and partners with internal and external legal counsel around contract strategy and enforcement.
- Delivers high-quality services and is committed to continuous improvement. Fosters a culture of safe and compassionate patient care.
- Makes well-informed, timely decisions, even when data are limited or solutions produce unfavorable results.
- Positions the organization for success by identifying new opportunities and builds the organization by developing and improving services.
- Leads the budgeting process
- Coordinates and partners with entity CFOs, Reimbursement and Revenue Cycle to align budget realization rates, charge master nuances and services as a bridge to payers to resolve differences.
- Coordinates, supports and is accountable to denial reduction initiative outcomes in cooperation with the VP of Middle Revenue Cycle and entity leaders.
- Uses cost-benefit thinking to set priorities, monitors expenditures in support of programs and policies, and identifies cost-effective approaches.
Qualifications
Education Requirements:
Master's degree required. Licensure/Certification Requirements: No licensure or certification required.
Professional Experience Requirements:
Requires a minimum of twelve (12) years of experience, with at least ten (10) years of people management experience. Experience leading within large integrated health networks and complex competitive commercial payer environments Knowledge/Skills/and Abilities Requirements:
- Understands the overarching System operations and policies that guide the organization.
- Adept negotiator and ability to leverage relationships, influence and executive presence to achieve the objectives of the role.
- Drives and develops innovative ideas and solutions with significance to the organization's future.
- Identifies problem areas and skill gaps proactively and addresses them appropriately.
- Excellent project management and change management skills for designing and implementing high-priority system or business group initiatives in a complex environment.
