• Job Description

  Req#: R2331620

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  Day - 08 Hour (United States of America)

  Stanford Medicine seeks an experienced leader to serve as Vice President of Managed Care and Payer Relations (VP), a highly strategic role that positions the organization for long-term success. This position is open due to the upcoming retirement of the 23-year veteran leader, Gary May. The VP will provide strategic leadership for contracting and managed care strategies for the Stanford Medicine enterprise: Stanford Health Care (SHC), Stanford Medicine Children’s Health (SMCH), Stanford University School of Medicine Faculty, Stanford Health Care Tri-Valley, affiliated Foundation Medical Group practices and capitated independent physician association (IPA). Reporting to the Chief Financial Officers of SHC and SMCH and working closely with the C-suites, this individual will be responsible for the strategy, negotiation, implementation, monitoring, and evaluation of all managed care payor contractual arrangements. This VP also oversees the negotiation, implementation, and ongoing monitoring of subcontracts for the enterprise in conjunction with the appropriate finance teams.
  
  Negotiating from a position of strength, this executive will make an immediate impact on short and long-term payor strategies that position Stanford Medicine for collaboration, growth, and delivering on a value equation. The role involves leading interactions with the payors as well as the senior leadership of the enterprise and is an outstanding opportunity for an experienced managed care executive with a proven track record of developing successful contracts and managing payor relationships. This leader will be essential in developing and implementing effective managed care strategies, including an emphasis on value-based care and population health. Historically, given the positioning of Stanford Medicine as one of the nation's premier tertiary/quaternary referral centers, contracted rates have been favorable and leadership would like this market positioning to continue going forward.
  
  The VP plays a critical role in shaping the future of the Department of Managed Care and is responsible for creating a strategic vision that aligns with the organization's goals and objectives. The candidate that will achieve the greatest success will be a seasoned managed care strategist, who understands payor strategies and have a successful track record in negotiating strong contract rates year-over-year. Stanford Medicine is seeking a top-flight contracting leader who is respected by payors, is strategic in outlook, and understands leverage and the use of analytics in negotiating on behalf of the enterprise. Candidates must have senior management payor contracting experience in one or more of the following: an integrated delivery system, hospital/health system, medical group, academic medical center or health plan environment that is recognized for innovative payor contracting including value-based models that create long-term "win-win" partnerships.
  
  The ideal candidate possesses exceptional leadership skills and the ability to effectively present and develop managed care strategies and tactics. This leader understands the diverse expectations of various stakeholders and prioritizes collegiality, teamwork, and open communication in their management style. The next VP must possess a comprehensive understanding of the ever-changing healthcare landscape. They should be well-versed in the dynamic changes that impact academic medicine, marketing strategies, managed care contracting, financial analysis of models, clinical and medical group management, and the intricate world of medical reimbursement. Additionally, experience with capitated delivery systems, delegated functions and responsibilities, transplant contracting, cost reporting, research protocols, and health system finance will be highly valued.
  
  Stanford Medicine is open to this person working remotely with the understanding that they must regularly be on campus to meet with key constituents.

  This is a Stanford Health Care job.
  
  A Brief Overview
  Responsible for overall management of the Department of Managed Care including developing and implementing the hospitals and physician groups managed care strategy and overseeing the development/maintenance of long-term productive relationships with payers and other constituencies which support SHC's and LPCH's strategic goals and objectives. The position collaborates with senior management, medical group leadership, service line administrators, and operational departments to develop and facilitate business development strategies. Responsible for the establishment of the pricing targets for the Charge Description Master (CDM) for SHC and LPCH.

  Reporting Relationships

  This position reports to the Chief Financial Officer for SHC, Linda Hoff, and the Chief Financial Officer of SMCH, Dana Haering. Direct reports include:

  • Senior Director, Managed Care (2)
  • Director of Managed Care (3)
  • Administrative Assistant

  Responsibilities

  Establishes and maintains an effective departmental organization:

  • Directs, in conjunction with human resource personnel, the selection, employment, compensation, and evaluation of department staff.
  • Manages departmental workload to achieve high levels of efficiency and productivity.
  • Collaborates with leaders and teams across Stanford Medicine.

  Manages negotiation, oversight, and operational implementation of all payer and managed care organization agreements:

  • Representing hospitals and physician practices developing, evaluating, and implementing strategies for establishing reasonable payer and managed care organization relationships to achieve Stanford Medicine’s objectives, including for Commercial, Medicare Advantage, and Managed Medi-Cal patient populations.
  • Develops standardized contract language terms and acceptable payment rates that are consistent with Stanford Medicine's financial and legal guidelines and overall contracting goals.
  • Ensures that contracts optimize pricing and strategically align hospital and physician incentives. Such contracts will account for the range of pre-eminent services and international standing offered by the Stanford Medicine academic medical enterprise.
  • Protects enterprise from contracting exclusions, redirection by payers, and erosion of the range of services available to patients.
  • Manages the development of databases and analytical tools to assist in the negotiation of contracts and the tracking, analysis, and reporting of contract performance.
  • Works with senior management, medical group leadership, and other appropriate personnel to ensure that Stanford Medicine meets contractual obligations.
  • Works with Stanford Medicine leadership to develop long-range forecasts given anticipated and realized contract rates and language terms.
  • Oversees the timely and effective implementation of contracts through communication with health plans, key SHC and SMCH personnel, and others as appropriate.
  • Oversees development and negotiation of Letters of Agreement, as needed.
  • Analyzes and reports contract performance and industry trends to senior management and medical group leadership periodically.
  • Collaborates with Stanford Medicine Government Relations to work with County and State officials on issues about Managed Medi-Cal contracts and terms.

  Works closely with the SHC Finance team to ensure an aligned approach on Finance workstreams, including:

  • Ensures service line reporting and analytics reflect managed care contracting strategies
  • Incorporates managed care contracting strategy and priorities with organizational strategic direction and initiatives
  • Communicates priorities and vision to operational and clinical leadership
  • Coordinates with strategic pricing and price transparency efforts, including modeling and assessment of impacts to pricing on anticipated net revenue
  • Works with the operating budget team to develop a revenue forecast

  Collaborates with various other SHC and SMCH departments regarding strategy, business development, marketing, and operational objectives:

  • Assists in the assessment of demand for hospital and professional services by major payers, geographic markets, clinical service lines, etc. Works with Accountable Care and Market Development teams to develop population health and value-based care strategy for SHC, SMCH, Medical Groups, and affiliates.
  • Works with Marketing, Business Development, Communications, and other departments to strengthen relations with employers and purchasing coalitions.
  • Develops strategies and communication efforts to represent Stanford Medicine on relevant public relations issues.
  • Assists in the development of assumptions for the annual operating budget and the Long-Range Financial Plan
  • Acts as a liaison in developing strong interdepartmental working relationships with senior management, department administrators, physicians, etc., for designated service line(s) regarding managed care strategy, contracting, and operational issues.
  • Works with a medical group, senior management, and service line administrators to identify programs to market, participates in program development, and identifies opportunities to improve the competitiveness of existing programs.
  • Chairs and/or attends meetings and committees as requested.

  General Leadership Responsibilities

  • Represents Stanford Medicine as a thought leader in outside organizations (AHA, CHA, AAMC, IHA, etc.) and internal constituents.
  • Works with the Office of General Counsel and outside counsel on litigation, depositions, and dispute resolution, as necessary.
  • Offers support, advice, and collaboration to Stanford Medicine Health Plan Operations on the development and management of health plan offerings.
  • Performs special projects as assigned.
  • Adheres to all Stanford Medicine departmental policies and procedures, by the Service Standards of the Hospitals.
  • Abides by all Joint Commission requirements including but not limited to sensitivity to cultural diversity, patient care, patient's rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
  • Performs all duties and responsibilities by the Service Standards of the Hospital(s).

  Candidate Qualifications

  • Bachelor's degree required with Master’s degree in health care administration, business administration, or related field preferred.
  • Minimum of ten (10) years of progressive management experience in managed care, business development, and marketing, or an equivalent combination of education and experience; experience in an academic medical center preferred.
  • Ability to create a strategic vision for the department, leadership skills, persuasiveness in presenting and selling managed care strategies and tactics, sensitivity to the expectations of the various constituencies, and a management style that emphasizes collegiality, teamwork, participation, and communication.
  • Knowledge regarding the changing dynamics of the health care environment, particularly as it affects academic medicine, marketing, managed care strategy/contracting, managed care Stanford Medicine Vice President, Managed Care and Payer Relations WittKieffer | 9 financial models’ analysis, clinical and medical group management, and the medical reimbursement environment.
  • Experience with capitated delivery systems, delegated functions/responsibilities, transplant contracting and cost reporting, research protocols, and health system finance.
  • Executive management experience in a highly complex, diverse organization, ideally prior academic medical center experience.
  • Experience with optimizing contract language and terms. Detailed knowledge of managed care principles, business models, preferred contract terms, and different payment structures such as fee for-service, value-based contracting, etc.
  • Strong understanding of the synergy between payor strategies and enterprise-wide strategic goals.
  • Proven record of accomplishment working collaboratively across an organization; a team player who can build solid working relationships within and outside an organization.
  • Innovative leadership skills to motivate and influence others; ability to establish mission and goals at the macro level, reconcile department and organizational goals, align subordinate management to work towards those goals, and inspire managers to ensure industry-leading services.
  • Skills in strategy development, systems planning, and change management, anticipating issues, and responding in an agile way; expert business development skills.
  • Interpersonal skills to maintain professional relationships with enterprise and industry leaders; ability to work collaboratively with all levels of employees and managed care partners through soliciting and incorporating their ideas when appropriate, and effectively managing conflicts to achieve win-win situations.
  • Innovative problem-solving abilities to assess intangible variables and think critically to evaluate fundamental issues and identify innovative, industry-leading solutions; expert ability to synthesize and analyze complex data and issues and to crisply articulate the impact.
  • Highly advanced verbal and written communication, facilitation, and presentation skills, and a highly persuasive style.
  • Demonstrated knowledge of health care financing, health plan structures, and health plan contracting.
  • Demonstrated ability to work collaboratively with other senior leaders to advance institution goals and maintain effective partnerships.

  These principles apply to ALL employees:
  
  SHC Commitment to Providing an Exceptional Patient & Family Experience
  
  Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all patients, families, and each other. C-I-CARE is the foundation of Stanford’s patient experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing, and recovery.
  
  You will do this by executing against our three experience pillars, from the patient and family’s perspective:

  • Know Me: Anticipate my needs and status to deliver effective care
  • Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
  • Coordinate for Me: Own the complexity of my care through coordination

  Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

  Base Pay Scale: Generally starting at $140.00 - $185.19 per hour

  The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

• About the company

  Stanford Health Care delivers the highest levels of care and compassion. SHC treats cancer, heart disease, brain disorders, primary care issues, and many more.

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