Vice President Managed Care

Job Overview:

This position requires a dynamic system thinking leader who can set the direction for TriHealth's managed care department and initiatives. This role must have a proven track record of working with peers and executives to develop and execute multi-year strategic plans and provide executive oversight for managed care operations.

This position must have experience balancing fee-for-service negotiations with value-based contracting to support TriHealth's strategy to maintain and continue as the region's leader in population health while also positioning TriHealth strongly to navigate the financial challenges stemming from governmental and commercial payor changes. This leader will proactively develop and influence relationships with payors, moving payors from non-collaborative to collaborative in their working relationship and financial negotiations for TriHealth. Additionally, this role will function as a key senior leader in the development and implementation of innovative solutions and products that drive value to the community and the TriHealth system. This position must foster internal relationships, align on goals with stakeholders, and deliver operational excellence while achieving defined metrics for success that move the system forward as thought leaders and first to market movers with managed care strategies.

Job Requirements:

Master's Degree in Management, Business, healthcare administration, organizational development

10+ years experience in Management

Thorough knowledge of legal and regulatory requirements labor laws, wage & hour, FMLA, EEO laws and a general knowledge of all human resources functional areas

Job Responsibilities:

Managed Care Operations; The Vice President is responsible for senior leader oversight of all day-to-day operations, including payer joint operating committees, Epic contract management, Revenue Cycle collaboration, and any projects/requests requiring Managed Care

Communication: The Vice President is responsible for effectively communicating the strategic and tactical plans of the department and system to stakeholders throughout the organization, including development of routine updates and any changes required to meet goals.

Internal stakeholders will view the Managed Care department as willing collaborators with each stakeholder/ group understanding their role in meeting the defined success metrics. The Vice President is also responsible for ensuring strong alignment between payors and TriHealth using effective communication to both convey positive outcomes as well as for resolving issues raised by stakeholders.

Strategic Planning: The Vice President is responsible for developing yearly and multi-year strategic plans for Managed Care, and for fostering executive feedback for inclusion in strategic plans.

The VP is responsible for developing the underlying tactics used to execute on strategy, and developing KPIs to monitor progress. Anticipates the impact of the market and environmental issues that affect the short and long term operations of the function; translates this vision into concrete goals that are easily understandable, measurable and sets departmental standards for success by integrating into staff expectations.

Negotiation and Playbooks; The Vice President will work in collaboration with Population Health leadership to develop and balance the fee-for-service and value-based contracting negotiating playbooks and execution to support TriHealth's journey of getting healthcare right and delivering quadruple aim care. Will proactively develop negotiation playbooks and strategy and ensure preparation for all key participants.

Budget and Forecasting; The Vice President will oversee and be responsible for budget development of the Managed Care department, and with assisting the system revenue budget.

Change Leadership: The Vice President will be effective at creating vision and managing change with all stakeholders to ensure proper execution of strategy and tactics. A key aspect is collaborating with staff to develop job performance standards which contribute to departmental and organizational success; recruiting and selecting staff based on position requirements and competencies; and empowering employees, through coaching and skill development, to assume the responsibility, accountability, and decision-making authority for their work area.

Other job-related information:

Direct Report FTEs: 0-2 FTE

Indirect Report FTEs: 3-9 FTEs

Working Conditions:

Leadership Performance Standards

TriHealth leaders create a culture of engagement, safety & reliability and high performance by consistently modeling and utilizing the following TriHealth Way leadership competencies, tactics and ALWAYS Behaviors to drive strategic pillar results:

Achievement of Annual Pillar Goals:

1. Safety/Quality, 2) Service, 3) Growth, 4) Culture/People, 5) Finance

Leadership Competencies:

TriHealth Way of Leading

TriHealth Way of Serving

Transformation Change

Drive for Results

Build Organizational Talent

Leadership Tactics:

Conduct department huddles. Generally, clinical departments hold daily huddles, non-clinical hold weekly huddles.

Regularly Round on Team Members, using questions from the rounding log.

• 25 or fewer team members = monthly
• 26-50 team members = every other month
• 51+ (and optional team members) = quarterly

Lead monthly team meetings using meeting agenda template; review stoplight report; cascade key leadership messages.

Model, coach and validate team members' use of TriHealth Way behaviors (AIDET + Promise, Always Behaviors and Always HEARD).

Recognize team members for safety wins, positive performance and demonstrating SERVE and ALWAYS behaviors, TriHealth Way of Leading, Serving and Delivering Care.