Responsible for managed care strategy and operations to drive financial results for Phoenix Children’s and Phoenix Children’s Care Network (PCCN). Position coordinates, evaluates and oversees implementation of managed care contracting and related responsibilities, value-based contracting initiatives, population health/clinical integration strategies, government contracts and partnering opportunities with regional employers. Continuously monitors the competitive environment and understands and monitors the trends that affect current and future healthcare business models and reimbursement. Collaborates with Finance, Strategy, Revenue Cycle and Administration in areas that managed care impacts organizational strategic initiatives. Responsibilities include strategic development of contract parameters and pricing and maintaining payer relationships to ensure optimization of contract terms. Oversight includes ensuring that all third-party payer contracts are negotiated, implemented and operationalized in accordance with Phoenix Children’s and PCCN requirements, established contract parameters, and strategic initiatives. Oversees provider enrollment, strategic pricing, and managed care contract approval/review functions. Position reports to the Executive Vice President and Chief Financial Officer.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
- Oversees contract discussions with managed care entities and other health care services providers and/or organizations. Manages contract language and rate negotiations in accordance with business and negotiation strategies and ensures contracts can be administered effectively and efficiently. Ensures contracts produce sustainable profit margins. Ensures all contract language and rates meet the standards, goals and objectives established by Phoenix Children’s and Phoenix Children’s Care Network, and that negotiations are conducted in a thorough and systematic manner, with adequate time allowances for review and approval by appropriate parties in conformity with department procedural guidelines and organizational procedures.
- Proactively anticipates and makes recommendations to resolve key operational and functional gaps that would prevent the successful implementation of payer arrangements and network strategies. Ensures enterprise contracts are implemented cross-functionally; coordinates contracting activities with other key constituents both internal and external to the organization. Collaborates, plans, coordinates, analyzes, and implements strategic and tactical approaches to meet clinical and financial expectations for clinical integration and population health-based contracts. Facilitates problem solving of operational issues through collaboration with managed care organizations (e.g. payers, networks, health plans, etc.) and internal stakeholders. Resolves contract interpretation issues to the root cause level.
- Provides strategic thinking and identifies areas where collaboration could increase access to care and provide optimal benefit and innovative opportunities for Phoenix Children’s, working with payers, community providers, caregiver’s employer groups, government programs and other community partners.
PCCN Program Collaboration
- In collaboration with the SVP and CMO of Phoenix Children’s Care Network, develop and adopt quality programs and measures, network performance standards, and other programs that promote the quality of health care through decreased cost, improved outcomes, and increased satisfaction for patients and families within the Phoenix Children’s enterprise utilizing population health management processes, techniques and systems. Coordinate implementation of integrated contract programs, strategies and performance monitoring across the Phoenix Children’s enterprise (PCH, PCMG, PCPC and PCCN).
Process Improvement and Project Management
- Identifies, communicates, and implements opportunities for process improvement. Manages multiple projects simultaneously and under tight deadlines. Assists with special studies and/or projects related to operations and/or reimbursement; prepares reports of findings and recommendations as appropriate.
- Analyzes financial, clinical and operational data to drive improvements in contract implementation and operations. Makes recommendations for business strategy, marketing and communications.
- Stays current in knowledge of contract terms, reimbursement models, widespread regulatory requirements and management trends.
- Performs miscellaneous job related duties as requested.