The Regional Executive Director, Operations will be responsible for the overall success of Steward Health Care Network Local Chapters in the assigned Region. He/She will be responsible for the implementation and ongoing leadership and management of Local Chapters and their performance in SHCN's risk and ACO/APO contracts. This will involve both leading the activities and staff associated with these efforts, and managing direct reports.
A critical function will be to 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. A key focus will be to improve quality, efficiency, and coding accuracy to drive positive patient outcomes while maximizing risk-based reimbursement for patient populations covered under risk/ACO contracts. The Executive Director will work to implement the collaborative, long-term population health management goals of the Local Chapter and Steward Health Care Network (SHCN).
He/she will work closely with Steward leadership and the Director 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.
He/she will assist the Medical Director is developing Local Chapter Governance to include Local Chapter Boards and Committees. He/She 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).
• Assesses the SHCN resources 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 Region, 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.
• 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.).
Managed Care Responsibilities:
• 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.
• 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 though 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/s he is recruited, as well as being responsive to the concerns and issues of the candidate.
• Work with Director of Network Development and other physician recruiters to develop and implement effective sourcing and recruitment strategies.
• Performs other duties as requested.
REQUIRED KNOWLEDGE & SKILLS:
• Understanding of the health care delivery setting. Experience with diverse populations a plus.
• Strong knowledge of managed care; ability to work independently and prioritize under short deadlines.
• Experience working with physician practices; demonstrates an understanding of practice operations.
• Strong communication skills; ability to interact with clinical care team and physicians in appropriate manner.
• Demonstrated quantitative and analytical skills.
• Excellent organizational capabilities and good attention to detail.
• Strong sense of diplomacy and ability to work under pressure.
• Ability to work in a dual reporting (matrix) environment.
• Ability to balance conflicting priorities.
• Leadership skills, ability to influence, form consensus and drive an agenda.
• Analytical skills to collect information from diverse sources and summarize the information and data in an order to solve problems.
• Ability to present information to small and, at times, large audiences of various skill levels.
• Must be able to maintain confidentiality of information.
• Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary.
• Ability to mentor and develop staff
• Creative, flexible, self-motivated professional must possess sound judgment ability to plan and initiate new activities consistent with achieving service excellence
• Demonstrated ability to effectively source and recruit qualified candidates
• Demonstrated understanding of medical manpower planning and the requirements of each individual market and / or specialty.
• Ability to effective interview, screen and establish rapport with candidates.
• Strong organizational skills to maintain large amounts of data and information on candidates, markets and the organization as a whole.
• Education: Bachelor's degree in relevant field (or equivalent combination of education and experience); Master's strongly preferred.
• Experience (Type & Length): At least ten years as a senior leader in a managed care environment of a similar capacity including negotiating a wide range of performance based arrangements. Management / supervisor experience require
• Software/Hardware: Strong knowledge in Microsoft Office applications – Word, Excel, Access, and PowerPoint; proven ability to learn new information systems as necessary.
• Other: Understanding of the health care delivery setting including both hospital and physician reimbursement and claims processing.