Senior Vice President, Managed Care and Payor Relations

Overview:

The Senior Vice President, Managed Care and Payor Relations is responsible for overseeing the managed care operations within the Jefferson Health System. This role involves strategic leadership, contract management, operational oversight, financial performance, and ensuring compliance with industry regulations. The SVP works closely with other senior leaders to integrate managed care strategies with the overall goals of the organization.

Key Responsibilities:

Strategic Leadership:

• Lead development of contracting strategy through collaborative and analytical approach partnering with population health, service line and overall delivery leadership
• Provide vision and direction for managed care operations, including value-based care initiatives and payer relationships.
• Collaborate with the executive team to drive the strategic direction and innovation in managed care practices.

Contract Management:

• Oversee the negotiation, implementation, and management of managed care contracts with health plans, insurance companies, and other payers.
• Ensure contracts are financially viable and aligned with the health system's goals.
• Manage and optimize payer relationships to enhance contract performance and resolve any issues.

Operational Oversight:

• Lead the managed care department, ensuring efficient and effective execution of operations.
• Implement and monitor processes to improve care management, utilization management, and operational efficiency.
• Utilize data analytics to drive decision-making and identify opportunities for improvement.

Financial Performance:

• Develop and manage budgets related to managed care operations, ensuring alignment with financial goals.
• Monitor financial performance and identify strategies to enhance revenue and control costs associated with managed care contracts.
• Provide regular financial reports and performance analyses to senior leadership.

Quality and Compliance:

• Ensure that managed care practices comply with regulatory requirements and industry standards.
• Develop and monitor metrics to assess and improve the quality of care provided under managed care agreements.
• Address and resolve compliance issues and audit findings related to managed care.

Team Leadership and Development:

• Lead, mentor, and develop the managed care team, fostering a collaborative and high-performance environment.
• Oversee recruitment, training, and professional development of team members.
• Promote a culture of continuous improvement and excellence within the managed care department.

Stakeholder Engagement:

• Build and maintain relationships with internal and external stakeholders, including payers, regulatory bodies, and healthcare providers.
• Represent the organization in industry forums, conferences, and meetings.
• Communicate effectively with senior leadership to provide updates on managed care performance and strategic initiatives.

Innovation and Change Management:

• Drive innovation in managed care practices, exploring new models of care and payment structures.
• Manage change processes related to managed care initiatives, ensuring smooth implementation and adaptation.
• Promote a culture of innovation and agility within the managed care team.

Qualifications

Key Qualifications & Experiences:

• Bachelors and Masters Degree required
• Extensive experience with healthcare providers or payor sites with a minimum of eight (8) years in a leadership role with oversight of managed care contracting and payor relations.
• Strong understanding of value based programs.
• Proven ability to collaborate with internal stakeholders including finance, health delivery, and population health teams.
• Success in leading teams through multi-site and multi-state managed care contract negotiations and management.

Closing Statement

About Jefferson

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.