Executive Vice President, Managed Care

JOB DESCRIPTION

Job Title:         Executive Vice President, Managed Care

Company:        The HSC Foundation/HSCSN

Reports to:      President  & CEO

Department:    Executive VP

FLSA Classification:   Exempt

Date revised:   March 2020

ABOUT THE HSC HEALTH CARE SYSTEM

The HSC Health Care System is a nonprofit organization combining the resources of a care coordination plan; (Health Services for Children with Special Needs, Inc.), pediatric specialty hospital (The HSC Pediatric Center), home health agency (HSC Home Care, LLC), and parent foundation (The HSC Foundation) to offer a comprehensive approach to caring, serving and empowering people with disabilities. The HSC team of 750 employees and more than 100 volunteers together serve children and young adults with special health care needs and their families at our District of Columbia and Maryland locations.

ESSENTIAL HSC MISSION AND VALUES

Mission Statement

HSC Health Care System provides and coordinates innovative, high quality, community-based care for individuals with complex needs and their families. HSC empowers all we serve to improve the quality of their lives.

Organizational Beliefs

HSC supports individuals and families to maximize their potential. The following beliefs drive our work. HSC believes that:

  • A culturally diverse community is a strength.
  • Inclusiveness for individuals, families, and staff promotes positive outcomes.
  • Everyone should be treated with compassion and empathy.
  • Our skillful, dedicated, and resourceful staff is key to our success.
  • We must continually adapt to the changing needs of our community.
  • Increased independence is an important goal for individuals and their families.

JOB SUMMARY

The EVP, Managed Care is responsible for assessing, designing and maintaining the most effective management and organizational structure to achieve the best possible results for HSCSN. Responsible for exploring other managed care opportunities in the DC metropolitan area.  Responsible for contract negotiation, development and compliance, strategic planning, business development, care coordination team and external provider compliance, productivity, member satisfaction and quality, financial planning and execution, employee relations, provider relationships and community and governmental affairs. Responsible for establishing and maintaining effective relationships with HSCSN and System operational management, as well as Children’s National Hospital.

 JOB FUNCTIONS

Essential job duties:

  1. Maintain a professional, productive, and healthy environment for patients and employees that promote both patient satisfaction and positive employee morale.
  2. Informs and advises the CEO and parent organization Board about current trends, problems, and activities within patient care services area.
  3. Participate in the development of the strategic plan and report goals and metrics to parent organization.
  4. Represents the health plan in its relationships with other healthcare agencies, organizations and groups.
  5. Actively participates, and encourages others to participate, in civic and community groups and organizations.
  6. Perform periodic analyses of the provider network from a cost, coverage, and growth perspective and provide reporting to senior leadership and parent organization evaluating opportunities to expand or change the network to meet organizational goals.
  7. Contributes as a key member of the senior leadership team and other committees to address the strategic goals of the organization.
  8. In conjunction with the Vice Presidents and the Medical staff, assess community needs and monitors utilization to ensure that the community is responding to the services provided.
  9. Reviews, approves and executes health plan contracts.
  10. Participates in the development of an organizational strategic business plan.
  11. Perform duties as senior liaison between the business unit, parent organization, and external stakeholders.
  12. Work proactively and collaboratively with peers at parent organization.
  13. Develops options and alternatives for the organization over the long term, including but not limited to exploring new managed care opportunities in DC, MD and VA.
  14. Work with senior leadership and parent organization to highlight health plan issues and track resolution progress.
  15. Ensures financial and operational viability.
  16. Conducts continuous assessment of programs and services.
  17. Remains abreast of local, regional, and national developments pertaining to managed care and advises leadership and parent board on implications and recommended actions.
  18. Develops measureable management objectives and plans.
  19. Assesses management and organizational performance, staffing and effectiveness.
  20. Identifies and pursues appropriate partnerships and affiliations.
  21. Supports the institution’s philosophy and mission to serve the community and promote fiscal profitability.
  22. Demonstrates use of performance improvement principles in daily approach to management team.
  23. Collaborates with the medical staff in areas that relate to patient care activities.
  24. Evaluates customer satisfaction data with department heads and ensures customer-oriented services through communication, responsiveness, and quality outcomes.
  25. Meet 100% of controllable budget goals.
  26. Effectively budgets and plans for necessary supplies, equipment, resources, and facility space. Budget requests are reasonable and justified.
  27. Creates special and/or recurring financial/accounting/billing/staffing/reports as needed/requested for area of responsibility.
  28. Maintains current knowledge in present area of responsibility (i.e. attends ongoing educational programs) Maintains skills, licensure, regulatory requirements, and credentials needed to perform assigned duties.

Other job duties:

  1. May perform other duties in addition to those outlined in this job description.

SUCCESS FACTORS

MANAGERS

Leadership Excellence, Collaboration, Leadership Skills

Leadership Excellence

  • Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved
  • Innovates through improvement of care and/or efficiency of operational processes.
  • Dedicated to a standard of performance excellence and high quality

Collaboration

  • Creates a safe environment that encourages brainstorming, creativity and “out-of-the-box” thinking
  • Encourages a diverse group of people to communicate effectively and embrace creative thinking
  • Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way
  • Demonstrates listening and feedback skills

Leadership skills

  • Proactively assumes responsibility and accountability for results to include management of organizational change
  • Empowers staff in ensuring a culture of transparency, fairness, respect and excellence
  • Strategically aligns operational and tactical objectives to drive business results.
  • Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication.

QUALIFICATIONS:

Required Experience:

  1. Management experience as COO or senior administrative officer of a health plan, preferably in leading, organizing and managing major projects, clinical and business services and functions.
  2. Broad and deep understanding of health plan/health care operating systems particularly those operating under a parent organization.
  3. Working knowledge health care issues, strategies and challenges.
  4. Verbal communication skills relevant to individual, small and large group discussion.
  5. Written communication skills that are qualitative, analytical and concise.
  6. Ability to coordinate with key operations and clinical leaders to develop and implement action plans to remediate risks/issues resulting from internal monitoring reviews and external audits/compliance actions
  7. Demonstrated ability to lead and incite teams and maintain positive professional relationships with team members and physicians.
  8. Demonstrated knowledge and ability in large scale project management, including strategic planning, business planning, financial and market analysis, contract negotiation, team facilitation and creative problem solving.
  9. Ability to develop strong working relationships with physicians and other health care professionals.
  10. Demonstrated knowledge of health care reimbursement principles, information systems, cost management, quality improvement and customer service concepts.
  11. Analytical, organizational, negotiation and problem-solving skills, with the ability to identify and achieve goals.
  12. Ability to negotiate a favorable outcome under difficult conditions.
  13. Self-motivated with demonstrated ability to take initiative, prioritize work, manage time and respond effectively to rapidly changing environment.
  14. Demonstrates service excellence and positive interpersonal relations in dealing with others, including members and families, employees, managers, medical staff, volunteers and community members, so that productivity and positive relations are maximized.
  15. Ability to manage a culturally diverse work force.
  16. Understands challenges of managing at-risk populations.
  17. Understands the needs of health plan operations in order to create and sustain a high performing delivery system.
  18. Capacity to identify, design, and implement new strategies and programs to support the organization’s mission.
  19. Capacity to generate financial and service results to sustain and improve the organization’s ability to meet the needs of its member population.
  20. Ability to develop and maintain high-level community and professional working relationships and contacts to aid the organization.
  21. Capacity to articulate the organizational goals, objectives and mission in a compelling manner.
  22. Capacity to respond effectively to competitive and performance challenges, through learning from others, collaboration, consolidation, elimination of non-performing services and the development of new services.

License/Certifications:

None required.

Required Education:

Graduate or advanced professional degree in management, medicine, health services delivery or related field.

SUPERVISORY RESPONSIBILITIES

The incumbent will be responsible for the general direction of staff members.

BLOOD BORNE PATHOGEN EXPOSURE

Category III: Job does not involve exposure to blood, body fluids, non-intact skin or tissue specimens. Incumbent does not perform or help in emergency medical care or first aid as a part of his/her job.

PHI ACCESS LEVEL

Level III – Episodic Access Incumbents in this job may only access protected health information related to customer’s episodic needs, the service(s) rendered and the position’s functions.

WORK ENVIRONMENT

This job operates in an office environment.

POSITION TYPE/EXPECTED HOURS/TRAVEL REQUIREMENTS

This is a full-time, regular position working standard and extended hours.

PHYSICAL REQUIREMENTS:

Light Work: Lifting 25 lbs. maximum with frequent lifting and/or carrying of objects weighing up to 10 lbs. Even though the weight lifted may be only a negligible amount, a job is in this category when it involves sitting most of the time with a degree of pushing and pulling of arm and/or leg controls, or when it requires walking or standing to a significant degree.

EMPLOYEE STATEMENT OF UNDERSTANDING:

I have read and understand this job description.  I further understand that this job description is not intended to be an exhaustive list of all the responsibilities, duties and skills required of this position.

Note:  External applicants, as well as position incumbents who become disabled, must be able to perform the essential functions, either unaided or with the assistance of a reasonable accommodation to be determined on a case by case basis.

For more information, see here.