Regional Director, Operations
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
This position is responsible for the overall success of Steward Health Care Network’s Local Chapters in the Ohio/Pennsylvania region, including accountability for the region’s performance in risk-based accountable care contracts and for the region’s financials. To include Care Coordination/Retention, overall Provider/Practice performance, Provider Relations: developing and maintaining robust retention strategies for Steward Health Care Network in our existing markets and for facilitating the paperwork and gathering the necessary provider data to add-on providers to existing PPAs.
This responsibility will be accomplished in partnership with the Regional VP of Operations, Director of Network Development, SMG Leadership and Hospital Presidents in consideration of their market’s needs along with other key internal stakeholders. Local Chapter Managers and Performance Liaisons in the region will report to this position.
This is a senior role with tremendous opportunity to impact a successful fast-growing health care system that values innovation, creativity and results.
- The Regional Director will drive performance by leading activities and managing staff in regional operations to generate the greatest potential value for the network in risk/ACO contracts, including:
- Lead a team to develop and execute Local Chapter performance improvement plans to generate the greatest potential value for the Network in the risk/ACO contracts.
- Assess the performance improvement needs of provider practices across the region and coordinate all to assist providers with maximizing value delivered to all key stakeholders.
- Partner with Performance team to improve quality, efficiency, and risk adjustment accuracy to drive positive patient outcomes while maximizing risk-based reimbursement for patient populations covered under risk/ACO contracts.
- Monitor, interpret, and report on changes in performance, market trends, health care delivery systems, and local legislative initiatives that impact their region and regional performance.
- Attend and/or provide oversight, support, and direction related to all regional Chapter, POD and Board of Directors meetings.
- Provide financial and operational oversight to the budget.
- Partner with RVP of Physician Network and Local Chapter Medical Directors to support Local Chapter Governance, including Local Chapter Boards and Committees. Use these physician governance forums as one key avenue to drive local performance.
- Implement the collaborative, long-term population health management goals of the Local Chapter and Steward Health Care Network (SHCN).
- Lead the Region and all practices that it is composed of, to meet or exceed all performance goals as set forth by the SHCN National Board of Directors in an effort to advance the Steward Community Care model, maximize patient and provider satisfaction, implement standards of care, and maximize risk-based revenues.
- Work closely with the physicians and clinical management team to monitor and ensure appropriate utilization of services in accordance with established standards through educational efforts, referral into SHCN programs, etc.
- Review individual physician performance in risk products and implement educational efforts and action plans as needed. Become local expert in all systems and processes such as referral management, HDS Quality Manager, and other tools available through the local chapter and system.
- Work with the Referral Management Team and Local Chapter Medical Directors in accordance with the Chapter’s specified referral management process to drive patient care into Steward Health Care Network and capture volume in our low-cost, high-quality Community Care Model.
- Ensure that new SHCN providers are effectively supported throughout the onboarding process and act as a central point of contact when issues arise that require escalation.
- Monitor availability of in network service gaps that need to be filled in order to keep patient care services in the Steward system and proactively manage physician and key hospital leadership relationships and brings critical issues needing attention to the SHCN and Chapter leadership team.
- Advocate for those services and resources that need to be brought to bear on improving the overall experience of providers in SHCN (e.g. additional IT support, new tools to manage referrals, etc.).
- Support Steward leadership and Steward’s Managed Care team to inform the design of performance programs and risk arrangements with managed care health plans, including:
- Develop effective relationships with counterparts at critical payers in the marketplace.
- Develop effective relationships with key stakeholders within Steward, to include the SHCN Leadership, Hospital Division Leadership and SMG leadership, as well as other executive and corporate leadership, hospital administrators and physician leaders.
- Effectively coordinate with key internal stakeholders to advance Steward’s vision to be a leading value-based health care system and incorporate such vision into the overall strategy and tactics.
- Create and communicate financial and risk terms with internal and external leadership.
- Secure support for negotiation goals and positions with both internal and external constituents through strong and effective persuasive skills and technical knowledge.
- Serve as expert on fiscal and legal provisions of each managed care contract in the market. Coordinate closely on key contracts with appropriate SHCN leadership.
- Lead resolution process with providers and health plans to address system-level claims or other operations issues.
- Support Steward Leadership and the Network Development teams to grow the number of Participating Providers in the Network, particularly with regard to Primary Care Physicians, and to assist in coordinating such activities in the Region.
- Interface with Steward Network Development (recruiting) as requested to grow and maintain the provider network.
- Strategic sourcing of candidates by initiating and maintaining networking relationships though medical associations, key contacts and visibility at professional conferences.
- Perform other duties as assigned.
Education / Experience / Other Requirements
- Bachelor’s degree in healthcare management, healthcare, business or other health related field (or equivalent combination of education and experience); Master’s strongly preferred.
Years of Experience:
- At least 8 years as a senior leader in a managed care or healthcare provider environment of a similar capacity. Management/Supervisor experience required.
- Understanding of the health care delivery setting including both hospital and physician reimbursement and claims processing.
- Understanding of risk-based reimbursement in commercial and government programs healthcare programs.
- Possesses specialized knowledge in accountable care, population health, or other related field/s; preferred.
- Strong knowledge in Microsoft Office applications – Word, Excel, Access, PowerPoint, and SharePoint.
- Accuracy and attention to detail required.
- Demonstrated ability to think critically and creatively.
- Ability to create, interpret, and disseminate information succinctly and clearly across multiple internal and external stakeholders, including providers.
- Applies strong project management techniques to take initiatives from idea to execution.
- Ability to work as part of a team and collaborate with colleagues across departments in a highly matrixed environment.
- Requisite poise, judgement, and trustworthiness to represent Steward to internal and external groups.
- Ability to adapt and respond to changes in environment and priorities.
- Ability to mentor and develop staff.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled