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About Cook Children’s Health Care System:

Cook Children’s Health Care System (Cook Children’s) is one of the country’s leading integrated pediatric health care systems. Based in Fort Worth, Texas, CCHCS is a $3.2 billion not-for-profit organization with over 10,000 employees, which includes a nationally recognized medical center, physician network, surgery center, home health company, health services company, health plan, and health foundation. Cook Children’s includes more than 60 pediatric medical offices and specialty clinics throughout Texas. Cook Children’s Medical Center is ranked in the top 5 percent of the nation’s hospitals for its nursing excellence and has a distinguished reputation for the extraordinary care and outcomes achieved in its specialty programs.

About the Position:

The President of Cook Children’s Health Plan, a key member of the Cook Children’s executive team with shared accountability for the success of the organization, is charged with guiding the strategy, profitability and sustainability of the Cook Children’s Health Plan (“Health Plan”).

Working with a team of subordinate executives, managers and staff to promote a culture of accountability, innovation and achievement, the President oversees all aspects of the Health Plan including finance, operations, clinical affairs, technology, regulatory compliance and community and government relations while demonstrating superior leadership, support of the CCHCS’s mission and vision, cultivation of high-performing teams, development and maintenance of cooperative and collaborative interdepartmental and external relationships.

The President has wide authority to accomplish goals, is a thought leader and strategic partner who relies on experience, judgment and collaboration with the System, hospitals, and physician leadership to strengthen the Health Plan and enhance outcomes.

Key Functions:

• Strategy and Planning
  • Establish short and long-term strategic priorities for the Health Plan in collaboration with the CCHP leadership, the CCHCS executive team, and the Board of Trustees. Offer unique insights and expert knowledge to influence goals, maximize opportunities, ensure sustainability and access to high quality care. Regularly collaborate with System leaders, entity leaders, clinical and operational departmental colleagues to make recommendations and drive consensus for the achievement of such initiatives.
• Board Collaboration and Representation
  • Confer with members of the Board of Trustees, executives and senior leaders to discuss issues, coordinate activities, or resolve problems. Prepare and present reports concerning membership, operational matters, quality, member satisfaction, financial performance, government actions, legislation, or rulings, and any other items affecting the Health Plan and managed care activities, programs and services.
• Health Plan Operations
  • Determine and formulate policies that guide and translate the Health Plan’s strategic objectives into daily activities. Coordinate activities at the highest level of management with the help of subordinate executives and staff managers, ensuring continuing operations, maximizing returns on investments, and increasing productivity and profitability.
  • Regularly assess operational effectiveness and achievement of objectives, making adjustments to ensure that Health Plan staff has the appropriate resources and employ the appropriate tactics to positively influence financial outcomes.
  • Make decisions and provide direction in a manner that supports the objectives of CCHCS and results in continuous improvement and best practice outcomes while providing a superior member and family experience.
• Clinical Affairs
  • Oversee the strategic development and direction of CCHP Clinical Affairs programs, to include Care Management, Utilization Management, Pharmacy, Credentialing and Quality Management. Collaborate with Physicians, System executives and members of the community to develop and execute programmatic initiatives, goals, policies and procedures to promote and improve the health of CCHP members through managed care.
• Community and Government Relations
  • Oversee the development and maintenance of the policies, procedures, and internal controls that guide and promote compliance with applicable federal, state, industry, regulations, laws, and guidelines and agencies that impact managed care, contracting, accreditation (e.g., Texas Health and Human Services, Texas Department of Insurance, etc.). Monitor and conduct system audits to identify breakdowns, assess effectiveness and make adjustments where needed.Represent CCHCS by promoting Health Plan objectives at official functions, or delegate representatives to do so. Preside over, or serve on, boards of directors, management committees, or other governing boards. Make presentations to legislative or other government committees regarding policies, programs, or budgets. Review and analyze legislation, laws, or public policy and recommend changes to promote or support interests of the general population or special groups. Deliver speeches, write articles, or present information at meetings or conventions to promote services, exchange ideas, or accomplish objectives.
• Fiscal / Resource Management
  • Direct the Health Plan’s financial activities to fund operations, maximize returns on investments, and increase efficiency by collaborating with subordinate executives and CCHCS finance leaders, developing and monitoring annual budgets, collaborating with other health care organizations and managed care plans to create new opportunities for growth.
  • Assist in planning, directing, and controlling the financial resources for the Health Plan by managing and tracking income and expenses related to the medical and administrative expenses of the plan’s operations.
• Data Analysis and Reporting
  • Compile and explore data to extract insights, patterns, and trends to answer questions, enable discussions and guide decision-making. Select and monitor key industry metrics/benchmarks for high-performing health plans, guide the development of dashboards and other reporting tools to communicate and monitor internal trends against historical performance, selected benchmarks, and established goals and objectives. Generate and distribute routine reports and conduct regular meetings with select leadership to review results, challenges, opportunities, plans, and goals.
• Regulatory Compliance
  • Oversee the development and maintenance of the policies, procedures, and internal controls that guide and promote compliance with applicable federal, state, industry, regulations, laws, and guidelines and agencies that impact managed care, contracting, accreditation (e.g., Texas Health and Human Services, Texas Department of Insurance, etc.). Monitor and conduct system audits to identify breakdowns, assess effectiveness and make adjustments where needed.
• Professional Collaboration
  • Participate in healthcare, managed care and health plan activities, associations, seminars, and roundtables to collaborate with peer organizations to learn new approaches and best practices in the industry. Apply this knowledge to Cook Children’s to produce outcomes consistent with high performing healthcare systems.
• Staff Management
  • Delegate appropriate authority to Health Plan leaders to effectively carry out necessary actions to achieve the goals and objectives while ensuring optimal customer service for members, and internal and external customers of the Health Plan while promoting a culture of accountability and innovation for the team. Create a team and an environment that fosters high employee engagement and satisfaction. Select and manage key Health Plan personnel including development, training, and education so that they are knowledgeable and competent in performing duties to which they are assigned.

The Ideal Candidate:

The ideal candidate brings a deep understanding of Medicaid managed care, along with the foresight to anticipate and adapt to evolving state and federal policies that shape the organization’s future. The President must have the ability to establish and maintain trust within the organization and a strong track record of effectively leading change. The President must be an exceptional communicator and have a willingness to listen and take input from different areas and levels of the organization and the health system. The successful candidate must lead Cook Children’s Health Plan with humility, compassion and integrity and have the ability to genuinely connect and inspire people.

Knowledge, Skills & Abilities:

• Superior leadership skills and experience, particularly in cultivating a high-performance team and in developing and maintaining excellent cooperative and collaborative interdepartmental and external relations.
• Extensive knowledge of and experience with governmental and commercial billing and collection standards, bylaws, rules and regulations for both hospital and professional services.
• Strong aptitude in collecting, analyzing, and reporting health plan data to identify opportunities and strategies for improvement
• Excellent communication skills, both verbal and written, including the ability to present complex information effectively to groups.
• Knowledge of and experience using health plan performance metrics to manage areas of oversight effectively.
• Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• Administration and Management — Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
• Consultation and Advice to Others — Providing guidance and expert advice to management or other groups on technical, systems, or process-related topics.
• Critical Thinking — Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Judgment and Decision Making — Considering the relative costs and benefits of potential actions to choose the most appropriate one.
• Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
• Monitoring and Controlling Resources — Monitoring and controlling resources and overseeing the spending of money.
• Problem Sensitivity — The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing that there is a problem.
• Problem Solving – The ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.
• Technology – Demonstrated proficiency with technology platforms, for example, the Microsoft Office Suite (Excel, Word, PowerPoint) as well as EPIC, and other industry specific applications and tools.
• Temperament – The ability to adjust level of emotional excitability or intensity as appropriate to the situation (e.g. remaining calm in stressful situations).
• Thinking Creatively — Developing, designing, or creating new applications, ideas, relationships, systems, or products.
• Time Management — Managing one’s own time and the time of others.

Minimum Requirements:

Experience

• 5+ years of executive level management experience in a health plan with a total of 15+ years of executive level management experience in a healthcare organization.
• Extensive understanding of applicable federal, state, industry, and payer rules, regulations, policies, laws, and guidelines that impact Health Plans.

Education

• Bachelor’s degree from an accredited college or university in Finance or Healthcare Administration.
• Master’s degree in Business Administration, Healthcare Administration or related field.

 

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