Job Description

Location: Steward Health Care Network
Posted Date: 6/7/2022

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.

Position Purpose: The Regional Vice President, Operations is responsible for growth and development of accountable care programs in the region. This position will also oversee and manage the finance and operations of accountable care programs across their region.

  • The Regional Vice President, Operations will be responsible for the overall success of Steward Health Care Network Local Chapters in their assigned Region. This individual will be responsible for implementation and ongoing leadership and management of Local Chapters and their performance in SHCN’s risk and ACO/APO contracts in the assigned Region. This will involve both leading the activities and staff associated with these efforts and managing direct reports
    • Assesses the performance improvement needs of provider practices across the Region and coordinates all to assist providers with maximizing value delivered to all key stakeholders
    • Knows and can articulate at any given time all PCPs and Specialists who are within the assigned area including key information such as group membership, affiliations, and historically contextual elements
    • Monitors, interprets, and reports on changes in performance, market trends, health care delivery systems, and legislative initiatives that impact managed care efforts (e.g., CMS, ACO regulations, Health Reform, etc.)
    • Attends and provides oversight, support, and direction related to all regional meetings and provides financial and operational oversight to the budget
    • Provides leadership, in conjunction with SHCN, on health-plan related initiatives and operations
  • Facilitate cross-business unit collaboration to scale ACO program operations regionally in order to support growth in and across the market. This includes:
    • Propose and implement policies, procedures, and processes that can be standardized regionally and tailored locally to meet the unique needs of the market
    • Collaborate with the Regional President to formulate strategies for the region; oversee the deployment of resources to the region to tactically support the strategies and drive performance
    • Partner with managed care and network development teams to drive regional growth in ACO programs, promote optimal network composition, and maintain provider participation in the network; improve provider engagement, loyalty, satisfaction, and retention
    • Partner with health plan leadership to identify and execute upon integrated growth opportunities across health plan and ACO divisions
  • 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. Improve quality, efficiency, and coding accuracy to drive positive patient outcomes while maximizing risk-based reimbursement for patient populations covered under risk/ACO contracts. Work to implement the collaborative, long-term population health management goals of the Local Chapter and Steward Health Care Network (SHCN)
    • Leads 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
    • Works closely with the physicians and clinical management team to monitor and ensure appropriate utilization of services in accordance with established standards through educational efforts
    • Reviews individual physician performance in risk products and implements educational efforts and action plans as needed. Becomes expert in all systems and processes such as referral management, HDS Quality Manager, and other tools available through the local chapter and system
    • Works 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. Ensures that new SHCN providers are effectively supported throughout the onboarding process and acts as a central point of contact when issues arise that require escalation
    • Monitors the availability of in network service gaps that need to be filled in order to keep patient care services in the Steward system and proactively manages physician and key hospital leadership relationships and brings critical issues needing attention to the SHCN and Chapter leadership team
    • Advocates 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.)
  • Work closely with Steward leadership and the Vice President of 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
    • Interfaces with Steward Network Development (recruiting) as requested to grow and maintain the provider network
    • Strategic sourcing of candidates by initiating and maintaining networking relationships through medical associations, key contacts, and visibility at professional conferences
    • Recruitment of qualified physicians includes initial screening, introduction of candidate to local area, responding to inquiries both about relocation as well as hospital/ practice questions in order to identify the best match of candidates with the appropriate opening
    • Retention of recruited physicians is based on the ability of the recruiter to manage expectations of the candidate with expectations of the practice / hospital into which he/she is recruited, as well as being responsive to the concerns and issues of the candidate
    • Work with Vice President of Network Development and other physician recruiters to develop and implement effective sourcing and recruitment strategies
  • Assist the Medical Director in developing Local Chapter Governance to include Local Chapter Boards and Committees. This individual will also assist Steward leadership and the Director of Managed Care to negotiate reimbursement rates, legal terms, performance programs, and risk arrangements with managed care health plans on behalf of Steward Health Care System, LLC (“SHCN”) (including Steward hospitals, physicians, and ancillary providers)
    • Executes on Steward’s vision to be a leading value-based health care system and incorporate such vision into the overall Managed Care strategy and tactics
    • Develops effective relationships with counterparts with the critical payers in the marketplace into order to position Steward to be able to effectively negotiate with the payers
    • Develops 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 coordinates with key internal stakeholders to advance the overall Managed Care Strategy. Creates and communicates financial and risk terms with internal and external leadership
    • Secures support for negotiation goals and positions with both internal and external constituents through strong and effective persuasive skills and technical knowledge
    • Provides support for the key Steward Health Care Network (SHCN) leadership meetings including: SHCN Board Meetings, the SHCN Finance Committee, and SHCN Negotiation Committee meetings
    • Serve as expert on fiscal and legal provisions of the contracts. Coordinates closely on key contracts with SHCN CFO and legal department.
    • Define and lead resolution process with providers and health plans to address system-level claims operations issues
    • Collaborates with SHCN leadership and guides the Regional Board to design and implement new operational models and structures to reduce costs, improve quality and enhance service
  • Perform other duties as requested

Education / Experience / Other Requirements

Education:

  • Bachelor’s degree in relevant field (or equivalent combination of education and experience); Master’s strongly preferred

Years of Experience:

  • At least ten years as a senior leader in a managed care or healthcare provider environment of a similar capacity
  • Management/Supervisor experience required

Specialized Knowledge:

  • 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.
  • Strong knowledge in Microsoft Office applications – Word, Excel, Access, and PowerPoint
  • Proven ability to learn new information systems as necessary

This position is subject to the COVID-19 Vaccination Policy for Steward Health Care Workforce. Employees in this position will be required to provide adequate proof of vaccination for COVID-19 by an FDA-approved vaccine prior to starting work. Steward will consider requests for exemptions from this vaccine requirement on the basis of medical condition or sincerely held religious belief in accordance with applicable Federal laws.

Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.


Additional Information

Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.

Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:

  1. Any COVID-19 related care takes place in designated areas away from other patients and their families.
  2. A stringent cleaning policy has been implemented throughout our facilities.
  3. A strictly controlled visitor and masking policy is required for patient and colleague safety.

You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.

Application Instructions

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