Vice President, Managed Care Service Area 1 (Remote)

Trinity Health•Livonia, MI

1d•Remote

About The Position

This position is "remote" and will require semi-regular travel within the Service Area 1 geographic region (IL, IN, IA, ID, OR and CA) and to home office in Livonia, MI. POSITION PURPOSE The Service Area 1 Vice President of Managed Care is responsible for payer contracting for the service area consisting of several Regional Health Ministries (RHM) across Illinois, Indiana, Iowa, Idaho, Oregon and California. This includes fee-for-service contracts and Alternative Payment Models (APM) based on quality and the total cost of care. Additional responsibilities include implementation of strategies to move Trinity Health into APMs in support of the Triple Aim. The VP of Managed Care understands the dynamics of both APM as well as the underlying cost structures that support the delivery of care within a healthcare system. The VP of Managed Care manages the full negotiation cycle from assessment and identification of value creation opportunities through implementation of the contract; provides leadership support for the RHMs within the region; negotiates and manages complex and innovative payer contracts; coaches team on advanced negotiation methods for APM contracting, such as risk-based contract and strives to maintain competitive reimbursement rates for the RHMs within the region. About Trinity Health Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. It is a family of 127,000 colleagues and more than 38,300 physicians and clinicians caring for diverse communities across 26 states. Nationally recognized for care and experience, the Trinity Health system includes 93 hospitals, 107 continuing care locations, the second largest PACE program in the country, 142 urgent care locations and many other health and well-being services. In fiscal year 2024, the Livonia, Michigan-based health system invested $1.3 billion in its communities in the form of charity care and other community benefit programs. ESSENTIAL FUNCTIONS Knows, understands, incorporates and demonstrates the Trinity Health mission, vision, and values in leadership behaviors, practices and decisions. Directs the development and execution of managed care related policies, procedures and processes in support of strategic objectives. Advises RHM senior management, network operations colleagues, and regional Managed Care colleagues on matters related to net revenues. Monitors outcomes and focuses resources to maintain the profitability and overall performance of payor relationships. Advises RHM contracting teams on matters of pricing and payer contracting. Responsible for overall fee schedule pricing including APM. Serves as an advisor to management regarding maximizing revenue from managed care products and makes recommendations regarding changes needed to enhance revenues. Develops goals for RHM contract performance and creates processes that ensure those goals are achieved. Provides guidance and coaching as needed to ensure positive contract performance to targets. Works in close collaboration with the Payer Strategy & Product Development leadership, Chief Financial Officers and other functional leaders in the development and implementation of Managed Care policies and procedures across the region. Grows the business unit by shaping and delivering APM projects. Oversees delivery of new contracts that leverage alternative reimbursement methodologies such as bundled payment and capitation. Crafts and approves contract protocol and language, develops national contract template with acceptable alternative language and provides support to RHMs and CINs on nonstandard language issues. Coordinates with and integrates legal support and resources. Formulates and leads the regional payer dispute resolution process. Monitors regional trends by payer. Maintains knowledge base by payer. Collaborates with recovery unit and coordinates with RHMs within the region. Directly supervises the regional Managed Care colleagues within the region and provides management oversight of professional and managerial staff within Managed Care. Performs all managerial tasks associated with effective day-to-day operations in accordance with Trinity Health mission, shared values, compliance requirements, performance standards, and administrative protocol. Develops contracting targets and recommendations in support of the Executive Contract Oversight Committee. LEADERSHIP COMPETENCIES As a Trinity Health Executive, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below: Mission Statement: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities. Core Values: Reverence: We honor the sacredness and dignity of every person. Commitment to Those Experiencing Poverty: We stand with and serve those who are experiencing poverty, especially those most vulnerable. Justice: We foster right relationships to promote the common good, including sustainability of Earth. Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care. Integrity: We are faithful to those we say we are. Safety: We embrace a culture that prevents harm and nurtures a healing, safe environment for all. Vision As a mission-driven, innovative health organization, we will become a leader in improving the health of our communities and each person we serve. We will be the most trusted partner for life. Promise Statement We Listen. We Partner. We Make it Easy. Our Actions Listen to understand. Learn continuously. Keep it simple. Create solutions. Deliver outstanding service. Own and speak up for safety. Expect, embrace and initiate change. Demonstrate exceptional teamwork. Trust and assume goodness of intentions. Hold myself and others accountable for results. Communicate directly with respect and honesty. Serve every person with empathy, dignity and compassion. Champion health equity and the common good Core Values: Reverence: We honor the sacredness and dignity of every person. Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable. Justice: We foster right relationships to promote the common good, including sustainability of Earth. Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care. Integrity: We are faithful to those we say we are. Safety: We embrace a culture that prevents harm and nurtures a healing, safe environment for all.

Requirements

Bachelor’s degree in finance, Accounting, Business Administration, Healthcare Administration, or related area along with ten (10) years of executive level experience leading Managed Care functions across multiple markets at a payer, network or healthcare delivery organization with an emphasis on negotiating contracts, or an equivalent combination of education and related work experience is required.
Successful past experiences managing complex change initiatives within payer/provider contracting and network development functions.
Broad based knowledge of healthcare finance, managed care, and health plan contracting.
Demonstrated competency in advanced contract negotiations.
Demonstrated success delivering results within the area of health care operations management.
Ability to communicate effectively and articulate all relevant operational perspectives.
Proven ability to be a creative and innovative thinker.
Proven commitment in a team setting, and ability to serve as a member of a management team.
Proven knowledge of how to get things done in a complex organization.
Ability to motivate others.
Strong analytical skills and effective verbal/written/interpersonal communications skills.
Ability to work in collaboration with and positively influence RHM executives to improve consistency and capabilities of payer strategies and contracting.
Must be able to explain the benefits of new Managed Care arrangements.
Must be able to adapt to frequently changing work priorities.
Must be able to travel as needed to the various Trinity Health sites.

Nice To Haves

MBA or MHA degree is strongly preferred.
FHFMA Certification, Fellow of the Healthcare Financial Management Association, and FAHM designation, Fellow of the Academy of Healthcare Management highly desired.

Responsibilities

Directs the development and execution of managed care related policies, procedures and processes in support of strategic objectives.
Advises RHM senior management, network operations colleagues, and regional Managed Care colleagues on matters related to net revenues.
Monitors outcomes and focuses resources to maintain the profitability and overall performance of payor relationships.
Advises RHM contracting teams on matters of pricing and payer contracting.
Responsible for overall fee schedule pricing including APM.
Serves as an advisor to management regarding maximizing revenue from managed care products and makes recommendations regarding changes needed to enhance revenues.
Develops goals for RHM contract performance and creates processes that ensure those goals are achieved.
Provides guidance and coaching as needed to ensure positive contract performance to targets.
Works in close collaboration with the Payer Strategy & Product Development leadership, Chief Financial Officers and other functional leaders in the development and implementation of Managed Care policies and procedures across the region.
Grows the business unit by shaping and delivering APM projects.
Oversees delivery of new contracts that leverage alternative reimbursement methodologies such as bundled payment and capitation.
Crafts and approves contract protocol and language, develops national contract template with acceptable alternative language and provides support to RHMs and CINs on nonstandard language issues.
Coordinates with and integrates legal support and resources.
Formulates and leads the regional payer dispute resolution process.
Monitors regional trends by payer.
Maintains knowledge base by payer.
Collaborates with recovery unit and coordinates with RHMs within the region.
Directly supervises the regional Managed Care colleagues within the region and provides management oversight of professional and managerial staff within Managed Care.
Performs all managerial tasks associated with effective day-to-day operations in accordance with Trinity Health mission, shared values, compliance requirements, performance standards, and administrative protocol.
Develops contracting targets and recommendations in support of the Executive Contract Oversight Committee.