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Position Details

Department: CORP | Administration
Category: Executives
Location: Phoenix
Posting #: 605997
Date Posted: 7/13/2021
Employee Type: Regular

Position Summary

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.

PCH Values

  • 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.

Position Duties

  1. Contract Negotiations
    • 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.
  2. Contract Implementation
    • 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.
  3. Payer Partnerships
    • 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.
  4. 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).
  5. 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.
  6. Business Oversight
    • Analyzes financial, clinical and operational data to drive improvements in contract implementation and operations. Makes recommendations for business strategy, marketing and communications.
  7. Industry Knowledge
    • Stays current in knowledge of contract terms, reimbursement models, widespread regulatory requirements and management trends.
  8. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
Education
1. Bachelors in Business, Finance, Health Care or related field. Required
2. MBA, MHA or MPA Preferred
Do you meet this requirement?
Experience
1. Eight or more years of experience in negotiating Managed Care contracts for various provider types such as hospital, medical group / IPA, physician and ancillary providers. Required
2. Experience with optimizing contract language and terms. Required
3. Experience with reimbursement methodologies under the AHCCCS. Required
4. Five or more years of management experience in a managed care environment within a health insurance carrier, hospital or medical group setting. Required
5. Knowledge of managed care principles, value-based contracting, business models, preferred contract terms, hospital and physician billing, claims payment methodologies and system requirements. Required
Do you meet this requirement?
Special Skills
1. Effective verbal and written communication skills. Required
2. Ability to maintain confidentiality. Required
3. Strong analytical, technical, and managerial skills. Required
4. Strong leadership skills with the ability to influence others. Required
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Occasionally
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Constantly
4. Physical Requirement - Hearing Constantly
5. Physical Requirement - Pushing/pulling Occasionally
6. Physical Requirement - Reaching Occasionally
7. Physical Requirement - Sitting Constantly
8. Physical Requirement - Standing Occasionally
9. Physical Requirement - Stooping/crouching/kneeling/crawling Occasionally
10. Physical Requirement - Talking Constantly
11. Physical Requirement - Tasting/smelling Frequently
12. Physical Requirement - Walking Frequently
13. Physical Requirement - Near Vision Frequently
14. Physical Requirement - Far Vision Frequently
15. Physical Requirement - Color Discrimination Frequently
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance Occasionally
18. Physical Requirement - Lift more than 35 pounds without assistance Occasionally
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply