Guardian Elder Care
  • Guardian Elder Care
  • State College, PA, USA
  • Full Time

Guardian Elder Care is a hiring a Vice President of Managed Care. Reporting to the CFO, the new Vice President, Managed Care Contracting and Payor Relations is responsible for evaluating, negotiating, and securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations on behalf of Guardian Healthcare. Additionally, this individual will participate in and support the development of managed care strategies and initiatives for Guardian to adapt to ongoing healthcare payment reforms and evolving payment methodologies, including but not limited to -- accountable care organizations (ACOs) and Value Based Care initiatives. The leader will foster professional relationships with private and public payor executives and serve as the principal liaison between Guardian and payors. This individual will also be responsible for representing the interests of Guardian in discussions with acute care systems or other care setting partners in discussions related to managed care.

Essential Functions

Key Relationships:

• Reports to the CFO, with accountability to Guardian Executive Leadership.

• Fosters professional relationships with private and public payor executives and serves as the principal liaison between Guardian and payors regarding contract changes and disputes.

• Works in close collaboration with respective Market Vice Presidents, NHAs, DONs and Guardian clinical care/quality teams to ensure that the needs of each SNF and Ancillaries are being met, while balancing the overall demands of Guardian.

 

Strategy and Business Development:

• Collaborates with Guardian's Leadership Teams, Market Vice Presidents and NHAs to identify contracting strategy and expansion opportunities, including development of managed care contracting strategy across units as appropriate and desirable.

• Supports the development of managed care strategies and initiatives for Guardian to adapt to ongoing healthcare payment reforms and evolving payment methodologies, including ACOs and VBC initiatives.

• Facilitates Guardian's involvement in defining the future payment/incentive model for the National or State (SNF, Home Health and NP) organizations for which Guardian is a member.

 

Contract Negotiations and Administration:

• Defines contract negotiation objectives in coordination with the Executive and Senior Leadership Team including opportunities to incorporate new technologies, procedures, and changes in the market.

• Manages and supports analytical staff in maintaining a detailed utilization database, including utilization and payment information by code, specialty, and payor benchmarked against Medicare and other payment rates.

• Coordinates with analytical resources to quantify the impact of alternative proposals before and during negotiations. • Leads contract negotiations with payors guided by Guardian's contracting priorities and informed by analysis.

• Negotiates contract language and facilitates review from legal counsel.

• Oversees monitoring of contract anniversary dates, reporting, and notification requirements, and ensures annual rates are implemented correctly and on time.

• Working in coordination with leadership teams, ensures that Guardian has the capability to track and report performance under any value-based or other pay-for-performance initiatives.

• Oversees and/or coordinates the collection, validation, and reporting of data for the Guardians business units and SNFs.

• Monitors health plans adherence to contract terms; identifies and resolves contractual disputes with payors in a timely, organized manner and in coordination with practice division revenue cycle and other staff.

 

Qualifications:

• Bachelor's degree in business, healthcare administration, or related field; Master's degree (MA) equivalent preferred.

• A minimum of ten years of managerial experience in managed care environment, health insurance industry, or managed care product development/negotiations, preferably in a faculty group practice setting.

Guardian Elder Care
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