RWJBarnabas Health is the most comprehensive health care delivery system in New Jersey, with a service area covering five million people. The system includes eleven acute care hospitals Clara Maass Medical Center in Belleville, Community Medical Center in Toms River, Jersey City Medical Center in Jersey City, Monmouth Medical Center in Long Branch, Monmouth Medical Center Southern Campus in Lakewood, Newark Beth Israel Medical Center in Newark, RWJUH- New Brunswick, RWJUH- Somerset in Somerville, RWJUH- Hamilton, RWJUH- Rahway and Saint Barnabas Medical Center in Livingston; three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital), a freestanding 100-bed behavioral health center, trauma centers, a satellite emergency department, ambulatory care centers, geriatric centers, the state s largest behavioral health network, comprehensive home care and hospice programs, fitness and wellness centers, retail pharmacy services, a medical group, multi-site imaging centers and an accountable care organization.
RWJBarnabas Health Medical Group is a multispecialty group practice comprised of highly trained and experienced world class primary and specialty care physicians. RWJBarnabas Health Medical Group physicians provide compassionate and innovative cutting-edge care for people at every stage of life at easily accessible facilities conveniently located throughout New Jersey. Backed by the vast continuum of resources of RWJBarnabas Health, the largest not-for-profit integrated health care delivery system in New Jersey and one of the largest in the nation, our dedicated physicians and expertly trained supporting staff continuously strive for clinical excellence.
Vice President, Managed Care Contracting and Payor Relations is responsible for evaluating, negotiating, and securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations on behalf of Rutgers Health Group (RHG) and its practice divisions. Additionally, this individual will participate in and support the development of managed care strategies and initiatives for RHG to adapt to ongoing healthcare payment reforms and evolving payment methodologies, including but not limited to -- accountable care organizations (ACOs) and clinically integrated networks (CINs). The leader will foster professional relationships with private and public payor executives and serve as the principal liaison between RHG and payors. This individual will also be responsible for representing the interests of RHG in discussions with other affiliated health systems or clinical partners in discussions related to managed care.
Reports to the CFO, Combined Medical Group with accountability to RBHS leadership.
Serves as member of RHG managed care committees at both RHG-NJMS and RHG-RWJMS; provides support and seeks consistent guidance from committee members regarding strategic direction and priorities.
Fosters professional relationships with private and public payor executives and serves as the principal liaison between RHG and payors regarding contract changes and disputes.
Works in close collaboration with respective practice division leadership and RHG leadership to ensure that the needs of each practice division are being met, while balancing the overall demands of RHG as an integrated practice.
Represents the interests of RHG in managed care related discussions with affiliated health systems.
Fosters relationships with RHG department chairs and faculty, clinical administrators, and other RHG and RBHS executives.
Strategy and Business Development:
Collaborates with RHG and practice division leadership to identify contracting strategy and expansion opportunities (e.g., through the development of new payor relationships, entrance into new markets, participation in new insurance products), including development of managed care contracting strategy across units as appropriate and desirable.
Supports the development of managed care strategies and initiatives for RHG to adapt to ongoing healthcare payment reforms and evolving payment methodologies, including ACOs and CINs.
Facilitates RHG involvement in defining the future payment/incentive model for the New Jersey Medicaid Access to Physician Services (NJ MAPS) program.
Remains abreast of local, regional, and national developments pertaining to managed care and advises leadership on implications and recommended actions.
Contract Negotiations and Administration:
Defines contract negotiation objectives in coordination with the Senior Vice Chancellor and Senior Associate Dean as well a practice division leadership, including opportunities to incorporate new technologies, procedures, and changes in the market.
Manages and supports analytical staff in maintaining a detailed utilization database, including utilization and payment information by code, specialty, and payor benchmarked against Medicare and other payment rates.
Coordinates with analytical resources to quantify the impact of alternative proposals before and during negotiations.
Leads contract negotiations with payors guided by RHG s contracting priorities and informed by analysis.
Negotiates contract language and facilitates review from legal counsel.
Oversees monitoring of contract anniversary dates, reporting, and notification requirements, and ensures annual rates are implemented correctly and on time.
Working in coordination with practice divisions and other managed care staff, ensures that RHG has the capability to track and report performance under any value-based or other pay-for-performance initiatives.
Oversees and/or coordinates the collection, validation, and reporting of NJ MAPS data for the RHG practice divisions to the state.
Develops and maintains appropriate policies, procedures, and controls for managed care and payor contracting activity.
Monitors health plans adherence to contract terms; identifies and resolves contractual disputes with payors in a timely, organized manner and in coordination with practice division revenue cycle and other staff.
Directs and manages assigned staff, including training, orientation, and counseling.
Works with the Senior Associate Dean to instill, maintain, and enhance in employees the vision, mission, and values of the University, RBHS, and RHG. Heightens employee morale via open lines of communication, fair and equitable treatment, and annual evaluations of all employees.
Selects, trains, directs, and evaluates the performance of and, when necessary, disciplines and discharges direct report personnel. Assists subordinates with difficult employee relations problems, as necessary.
Understands and adheres to the University s compliance standards as they appear in the RBHS Corporate Compliance Policy, Code of Conduct, and Conflict of Interest Policy.
Performs other related duties as assigned.
Bachelor s degree in business, healthcare administration, or related field; master s degree (MA) equivalent preferred.
A minimum of ten years of managerial experience in managed care environment, health insurance industry, or managed care product development/negotiations, preferably in a faculty group practice setting.
Extensive experience with contract negotiations and payor relations, as well as demonstrated knowledge of legal, regulatory, and operational aspects of managed care.
Experience and familiarity with physician/professional service compensation, fee schedules, and resource-based relative value scale (RBRVS) - based reimbursement.
Experience and understanding of new and evolving value-based payment arrangements and related financial/actuarial models, such as capitation, shared savings, and payment bundles.
In depth understanding of payor delegated models and strategies, inclusive of HEDIS, 5-Star, PAF/HCC, and other quality, utilization, and financial models.
Experienced with payor denial management, contestations, audits, and appeal resolution.
Familiarity with patient accounting tasks including billing, collections, and reimbursement analysis.
A track record of success working in an environment of collaboration, transparency, mutual respect, and shared passion for excellence and innovation.
The ability to plan, organize, prioritize, allocate resources, and manage multiple ongoing, concurrent projects.
The ability to express oneself clearly and concisely both orally and in writing.
Note: Position will require travel to various locations relative to RHG and the Combined Medical Group. Primary locations include Newark, New Brunswick, and West Orange.
We offer a great work environment, competitive rates and excellent benefits, including:
Short & Long Term Disability
Basic Life & Accidental Death Insurance
Health Care/Dependent Care Flexible Spending Accounts
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.