AVP Managed Government Program
About the Job
Do you want to join an organization that invests in you as an AVP Managed Government Program? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.
At HCA Healthcare, we want to ensure your needs are met. We offer eligible colleagues an attractive benefit package that includes medical, wellbeing, dental and vision benefits along with some unique benefits including:
- Medical, Dental, Vision, Life Insurance and Flexible Spending
- Paid Time Off (PTO) and Personal Leave
- 401K (100% annual match - 3% to 9% of pay based on years of service)
- Academic Assistance and Reimbursements for Tuition and Student Loans
- Employee Discounts including Tickets, Retail, Mental Health Apps, Education Apps, Identity Theft Protection etc.
- Home, Auto, and Pet Insurance
- Employee Stock Purchase Program (ESPP)
- Short Term & Long Term Disability coverage
- Adoption Assistance
- Legal Benefits and lots more!
You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated AVP Managed Government Program like you to be a part of our team.
Job Summary and Qualifications
At the direction of the Regional VP of Managed Government Programs in the Payer Contracting & Alignment department, you will participate in supporting the strategic course for assigned markets to promote maintenance and optimization of the fee-for-service price/volume equation, including seeking opportunities for alternative payment models (APMs) in order to maintain and grow managed government net revenues. You will administer, coordinate and support all negotiation, contracting and reporting activities relative to managed government programs on behalf of the HCA facilities in the markets comprising the AVP’s assigned responsibility portfolio, pursuant to the division or market business/financial plan and PC&A policies and procedures.
The PC&A AVP will be located in Richmond, Virginia, with responsibility for the following states: Indiana, New Hampshire, Virginia, Kentucky and South Carolina
Your responsibilities will include:
- The primary responsibility of the AVP is to obtain and maintain contracts with Managed Government Program payers, optimizing the fee-for-service price/volume equation of a net revenue portfolio greater than $.5B but no more than $2.5B, and which includes hospitals, behavioral health facilities, provider-based (free-standing) emergency departments, ambulatory surgery centers and various ancillary provider types, including maintaining connectivity with the Company’s employed physicians (PSG) and other referral alignment vehicles under APMs.
- Maintain current knowledge of State and Federal regulations, laws and legislative agendas regarding the healthcare industry, paying particular attention to those involving state Medicaid and managed care, CMS federal programs for FFS Medicare and Medicare Advantage, as well as healthcare reform. Engage and coordinate with HCA’s internal government relations team and state hospital associations to monitor regulatory and legislative changes, and provide formal guidance on risks and opportunities that may impact the managed government portfolio.
- The AVP is responsible for providing input on his/her area of expertise in the preparation of the annual Market Strategic Reviews (as applicable) and PC&A budget packet with his/her RVP for each market, at the direction of the PC&A CVP of Managed Government Programs.
- The AVP will oversee the successful coordination, negotiation and implementation of contracts with Managed Care Organizations (MCOs) operating in the managed government space and maintain effective working relationships with his/her MCO counterparts.
- The AVP will ensure that all required processes and available strategic pricing, legal, reporting and communication tools will be deployed in order to both (a) maximize contract performance/yield (e.g., Net Revenue, NRAA, Net Revenue relative to traditional Medicare/Medicaid reimbursement, Contribution Margin, etc.), and (b) be consistent with the Division’s contribution margin and/or EBIDTA and pricing objectives. Among these requirements will be maintaining an effective working relationship with the Analytics & Pricing Services (A&PS) and PC&A Legal department staffs and adeptness with Qlikview, Cash Reconciliation Reports and Service Line tools.
- The AVP will collaborate and assist with his/her Commercial PC&A and PC&A-Physician Services Group (PSG) colleagues relative to contracting activities with MCOs and other payers, as may be required from time to time.
- The AVP will monitor Managed Government Program payers’ performance via regular reviews of payer volume, rate and yield, including volume/yield and cash reconciliation reporting on at least a quarterly basis. The AVP will also be heavily involved in denial management activities, from avoidance (by securing robust contract protections) to information gathering (via regular meetings with Case Management and SSCs and participation in DMAT) to resolution (via JOCs and other problem-solving interfacing with the MCOs) to disputes (via involvement with PC&A Legal, SSC Legal, external counsel and other dispute resolution processes).
- Supervise, oversee and develop direct reports (if any/as applicable) in accordance with their job descriptions, all Company requirements and the dictates of personnel management best practices.
- Actively participate as a key member of HCA’s Group/Division/Market operations management team as applicable, and provide input for annual business plans, education on managed government legislative issues and support for annual budgets and other communication strategies for assigned markets.
- As a key member of the PC&A senior management team, participate in strategic development initiatives as assigned by the RVP or CVP, including but not limited to such things as APMs (e.g., capitation, pay-for-performance (P4P), bundled payments, volume guarantees, etc.), contracting practices (e.g., language standards, protective provisions, etc.) and subject-specific task forces as may be assigned.
- Comply with standard Company reporting and signatory requirements, including but not limited to timely updating and submitting the Monthly Operating Report (MOR) and various other monthly reports as applicable and assigned (e.g., Major Payer Update, ASC Update, Completed Contracts Report, Behavioral Health Update, etc.), participating in the development and presentation of annual Strategic Market Reviews and Contract Strategy Presentations (CSPs), adhering to Contract Process, Team Room and C-Trax requirements, evaluating and processing APM initiatives, completion and documentation (in HealthStream or in-person attendance) of annual Code of Conduct, Physician Relationship, Information Protection and other required training activities, business/travel expense processes through Concur, human resources policies and procedures (e.g., use of TMS/Authoria system for goal-setting, performance evaluations, etc.), and so on.
- Ensure that a permanent record of all negotiations and documentation relating to Managed Government Program contracting activities is maintained in local files, electronic files and/or C-Trax (or as may otherwise be permitted/required); provide copies of finalized documents to the SSC and (as applicable) Ambulatory Surgery Division (ASD) and PSG; and provide for administration of completed contracts and amendments through formal in-servicing and other summary documents to PSG, SSC, Case Management and other key stakeholders, in order to enable them to better operationalize such MCO contracts.
What qualifications you will need:
- Bachelors Degree is required; Master’s Degree preferred, equivalent experience considered
- 10 years' experience in care contract negotiation experience, whether for a hospital system or MCO
- Managed Care experience, specifically in the areas of financial analysis, payment methodologies, contract language and negotiations.
- Fluent in such systems as Word (including editing documents via redline features), Excel, Pivot Point tables and PowerPoint presentations, etc.
- This position may require overnight travel up to 20% of the time.
HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry.
HCA Healthcare has been named one of the World's Most Ethical Companies by Ethisphere Institute for over a decade. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"Good people beget good people."
We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our AVP Managed Government Program opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.