Provides strategic leadership as well as financial and administrative oversight of third party payer relations for the OU Health Enterprise including the evaluation, negotiation, implementation, and subsequent monitoring/maintenance of both fee-for-service and value/risk based contracting. The OU Health Enterprise includes OU Medicine Inc. (Hospitals) and OU Physicians (Physician/Clinics), and thus this job incorporates both hospital and provider aspects of managed care contracting.
This position is a dual report to OU Medicine Inc. Chief Financial Officer and the Chief Administrative Officer of OU Physicians.
Position is responsible for a strong portfolio of managed care contracts and related programs with an emphasis on maximizing revenue and attaining operational goals of the organization. Also provides strategic direction for the development of Clinically Integrated Networks (CINs). This position acts as primary liaison within the organization and for other organizations with regard to managed care issues. Serves as a member of the senior management teams responsible for planning, allocating, and monitoring resources to support the organization’s mission, strategic plan, and quality improvement initiatives.
Essential Responsibilities: Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.
Develops and oversees all aspects of evaluating, negotiating and implementing fee for service, value-based and special program contracts and more broadly contributes to OU Health’s efforts to develop and execute strategies to strengthen OU Health’s position in the evolving managed care market place.
Responsible for assessing legal and financial implications of all contracting opportunities including new contracts, renewal contracts, contractual amendments and assignments to existing contracts.
Develops overall managed care contracting strategy in alignment with the overall OU Health strategy
Represents OU Health entities to all third party payers.
Communicates and interacts with health care plan and insurance brokers, physicians, company representatives, and business community individuals to obtain market information, to negotiate claim disputes, and to clarify standards/processing requirements.
Monitors managed care contract performance for both hospital and provider reimbursements and ensures that third party payers adhere to contract parameters.
Develops and maintains strong relationships with internal clinical providers and groups.
Serves on boards, committees, and councils as assigned or as appropriate as company representative; coordinates and schedules presentations related to managed care functions, resources, and strategies.
Provides direction and oversees management of area and develops and implements policies and procedures for area of responsibility.
Strategy development includes market assessment, financial modeling, relationship management with employers and payors.
Monitors the public and fiscal environments to predict/evaluate potential impact on current and future contract activity.
Hires, trains, develops, coaches, supervises, counsels, and evaluates Managed Care staff; develops and communicates program processes and procedures.
Ensures orientation, in-service education, competency, and continuing education of all persons in areas of responsibility.
Continuously assesses and improves areas of responsibility in accordance with performance improvement plans.
Prepares and submits budgets for managed care programs in accordance with established deadlines; monitors budget compliance and takes corrective action for deviations as needed
Integrates areas of responsibility with the health system’s primary functions and other departments in accordance with health system strategic and operational plans
Responsible for Managed Care Contracting Committee which will review and recommend contracts to the OUMI Board.
Recommends to the Board managed care contracting parameters and guidelines, including compensation and risk parameters and delegated credentialing
Responsible for Managed Care Contracting Committee which will review and recommend contracts to the OU Board of Regents
Recommends to the OU Physicians Operations Council managed care contracting parameters and guidelines, including compensation and risk parameters and delegated credentialing
Knowledge, Skills and Abilities:
Results oriented with strong business and financial acumen and a deep understanding of the role Managed Care plays in helping the organization achieve its business goals.
Demonstrated knowledge of managed care including both hospital and physician elements, including managed Medicare and Medicaid, and other payor’s guidelines and criteria for reimbursement.
Facile with insurance billing, coding and terminology.
Knowledge of ongoing healthcare trends, legislation, and reimbursement standards.
Requires legal knowledge sufficient to understand and draft contract documents.
Work requires strong negotiating skills, as well as strong analytical and strategic thinking capabilities.
Possesses ability to plan, direct and supervise the work of a diversified staff.
Work requires ability to work in large, complex matrix organizations.
Work requires strong team building skills to gain consensus of multiple entities on contracting issues.
Requires financial skills sufficient to evaluate or produce complex fee schedule analysis.
Consistently demonstrates solid organizational skills, time management, and professionalism.
Must possess advanced interpersonal skills to effectively interface with all levels of faculty and staff as well as external business-related associates.
Demonstrated ability to develop collaborative relationships with key stakeholders. Strong influence skills and ability to motivate others.
Must demonstrate the ability to provide leadership and effectively communicate both verbally and in writing to all levels within
COMPANY BACKGROUND/ CULTURE
OU Medicine — along with its academic partner, the University of Oklahoma Health Sciences Center — is the state’s only comprehensive academic health system of hospitals, clinics and centers of excellence. With 11,000 employees and more than 1,300 physicians and advanced practice providers, OU Medicine is home to Oklahoma’s largest physician network with a complete range of specialty care. OU Medicine serves Oklahoma and the region with the state’s only freestanding children’s hospital, the only National Cancer Institute-Designated Stephenson Cancer Center and Oklahoma’s flagship hospital, which serves as the state’s only Level 1 trauma center.
OU Medicine Mission & Values
At OU Medicine, their mission is leading health care – in patient care, education, and research. Through our combined efforts, we strive to improve the lives of all people.
Their vision is to be the premiere health system for advancing medical care, education, and research in the state and to be among the leaders nationally.
OU Medicine believes that caring for their patients must be at the center of all they do. They do this with honesty and integrity. They magnify their effectiveness through teamwork, open and effective communication, and respect among colleagues and co-workers. They seek to continually improve by harnessing innovation and encouraging high performance. They are committed to providing outstanding educational programs, and through this they will be the leader in the advancement of basic and clinical research.
OU Medicine offers enhanced resources and programs to proudly serve their multicultural and diverse patient population. They embrace excellence in inclusion and value staff and faculty with unique experiences and backgrounds. They realize that their diverse workforce is critical to the success of their commitment to advancing and leading health care.
OU Medical Center
OU Medical Center is Oklahoma's most comprehensive hospital dedicated to defining medicine with cutting-edge treatments and working toward solutions for each patient, every time. It is located in the heart of Oklahoma City, just minutes from the beautiful, new Bricktown area and the State Capital. They provide a full range of hospital services for every patient, from the smallest neonate to the most critically ill senior.
Their 350-bed hospital provides services not offered elsewhere in the state, including Oklahoma’s only Level I Trauma Center. They provide a full range of heart care services at OU Medicine Cardiovascular Institute, the state’s premier center for treating cardiac and vascular patients.
They offer the highest level of care for stroke patients when “time is brain,” and provide unmatched neurology and neurosurgery services ranging from the diagnosis and treatment of epilepsy to advanced “keyhole” and “awake” brain surgeries.
They also offer cancer care working alongside Stephenson Cancer Center, the state’s only NCI-designated cancer center, including a Gamma Knife Center for treating brain tumors that can't be treated by conventional methods, CAR-Therapy, Proton Therapy and a Bone Marrow Transplant Center. They have the most experienced transplant team in the state at the Oklahoma Transplant Center. They are on the cutting edge of orthopedics treatment with the largest orthopedics team in Oklahoma.
OU Medical Center broke ground on an expansion project in July of 2017 that is the largest healthcare construction project in Oklahoma state history. The new OU Medical Center patient tower is set to open in late 2020 and will include:
450,000-square feet of additional space
Eight floors and room to grow
144 added beds
32 new operating rooms
Intensive care unit
Large patient rooms with extra space for the family
The Children’s Hospital
The Children’s Hospital has 325 inpatient beds and is the only freestanding pediatric hospital in Oklahoma solely dedicated to the treatment of children. Their pediatric staff blends years of specialized pediatric training with education, research and technology to treat conditions ranging from cardiothoracic and oncology-related illnesses to neonatal specialty care and pediatric solid-organ transplants. Their 93-bed neonatal intensive care unit provides the highest level of neonatal care in Oklahoma. The Children’s Hospital will open a new, state-of-the-art pediatric intensive care unit with 34 beds in July of 2019.
The Children’s Heart Center brings cutting-edge research, treatment and surgery to patients with congenital and acquired heart conditions. They have the state’s largest staff of child life specialists to help children and families cope with hospitalization.
U.S. News & World Report also ranks Children’s as one of the best urology programs in the country.
Women’s and Newborn
Part of The Children’s Hospital, their Women’s and Newborn services are the largest in the state with over 4000 deliveries annually.
OU Medical Center Edmond
For over 65 years, OU Medical Center Edmond has cared for the citizens of Edmond much like members of the family. As Edmond's community hospital, they have been an active participant in the impressive growth of the city and look forward to continuing our tradition of being partners in their patients’ health.
At OU Medical Center Edmond, they combine the innovation and research of OU Medicine with compassionate community hospital care for the residents of Edmond, northern Oklahoma County, southern Logan County, and beyond.
They are accredited by the Joint Commission and their 200 physicians on staff represent more than 50 specialties. Their 450 dedicated employees and 90 loyal members of the volunteer auxiliary are members of the Edmond community and are actively involved in enriching the lives of their citizens not only through their work at the hospital, but through volunteerism and outreach activities as well.
2010 began a new era for the hospital and healthcare in Edmond when the facility became a part of the OU Medicine family. By combining with Oklahoma's largest hospital, area residents now have expanded access to world class medical research and cutting edge treatments.
In the past four years, the facility recently completed renovations and technology investments totaling 24 million dollars to ensure that Edmond residents would have the best, most comprehensive services available to them close to home. These investments include the most advanced daVinci Surgical System available in the region, digital mammography services, the GE Optima 450W, the only one of its kind in the metro. In addition, OU Medical Center Edmond is proud to offer the only Endobronchial Ultrasound (EBUS) in the area for patients suffering from lung disease. This hospital is also the only facility in the metro offering S.T.A.R. ankle replacement surgery.
Additionally, all patient rooms throughout the facility have been renovated to enhance the patient experience. New furniture, flooring, bathrooms, and doors create a soothing environment that is quiet and private.
The state’s largest physician group, OU Physicians is also a key player in Oklahoma’s largest academic medical system. With more than 1,200 physicians and advanced practice providers, OU Physicians encompasses nearly every adult and child specialty; many of our providers have expertise in the management of complex conditions unavailable elsewhere. OU Physicians providers not only offer exceptional patient care, many hold faculty positions with the University of Oklahoma College Of Medicine, applying their expertise to training the next generation of healthcare professionals. In addition to teaching and mentoring, they also are active in life-saving research. According to data collected through patient satisfaction surveys, OU Physicians ranks among the top practices in the country in overall patient experience.
OU Children's Physicians has over 150 specialists committed to the care of children. The majority of OU Children's Physicians are board-certified in children's specialties. Many provide pediatric-specific services unavailable elsewhere in the state. Some have pioneered surgical procedures or innovations in patient care that are world firsts.
Patients visit OU Physicians clinics seeking treatment for common illnesses, or to inquire about general medical concerns, but they come back for the compassionate, continuing care that family doctors provide and the individual interest they invest in their problems. There are currently 12 Primary Care Clinic locations and 3 Community Health and Wellness Clinics in the system.
OU Health Sciences Center
One of the most comprehensive academic health centers in the nation, the University of Oklahoma Health Sciences Center (OUHSC) has campuses in Oklahoma City, Tulsa, and Lawton, six professional Colleges and the Graduate College, and research centers of excellence such as the Stephenson Cancer Center, Harold Hamm Diabetes Center, Reynolds Oklahoma Center on Aging, and Dean McGee Eye Institute, and the state’s largest clinical group practice OU Physicians with over 1,200 credentialed providers. Based upon the size and scope of its current research, training programs, and patient care delivery system in partnership with OU Medicine, OUHSC serves as the state’s premier healthcare training institution for over 3,300 students and nearly 800 residents and fellows, graduating physicians, biomedical and clinician scientists, nurses, dentists, pharmacists, allied health professionals, and public health leaders.
Prominent OUHSC researchers receive the largest portfolio of National Institutes of Health (NIH) funding in the state, and commercialize new treatments and diagnostic tests, utilizing state-of-the-art research facilities such as the University Research Park and Stanton L. Young Biomedical Research Center.
Scientists, scholars and clinicians appointed to OUHSC faculty stand at the leading edge of their professions, and have contributed to Oklahoma’s history and growth for the past 125 years.
The University of Oklahoma College of Medicine
The University of Oklahoma College of Medicine is a special place, opening new frontiers in education, research and patient care. The College of Medicine is the largest component of the University of Oklahoma Health Sciences Center and is at the center of OU Medicine. Their mission is leading health care: in education, research and patient care.
The University of Oklahoma College of Medicine is comprised of 22 academic departments. The OU College of Medicine has conferred the Doctor of Medicine degree to more than 10,000 graduates since the College’s official founding in 1910. In addition to conferring the Doctor of Medicine degree, the OU College of Medicine offers residencies and fellowships in numerous specialties and subspecialties.
Beyond the traditional medical degree, the OU College of Medicine also offers a robust biomedical research education program, a competitive Physician Associate program and other dual degrees to meet students’ unique interests and goals.
Education: Bachelor’s degree in Business, Healthcare Administration or related field. Juris Doctorate or Master’s degree preferred.
Experience: 6 or more years of progressively more responsible management experience in the managed care or clinical health care environment with emphasis on contracting, finance, or operations. Work experience in an academic medical center strongly preferred.
Or equivalent combination of education and experience. Licensure/Certifications/Registrations Required: N/A
Internal Number: #0002
About Southerland Group/ OU Health
Southerland Group is a nationally recognized retained executive search firm with specialization in complex integrated delivery systems, academic medical centers, children’s hospitals and payer organizations. Our strategic approach and commitment to long-term client relations promotes a true understanding of the issues facing healthcare organizations and enables clients to recruit and retain top leadership talent both in and outside of the healthcare industry. Our tailored search and retention processes allow our client partners to recruit leaders from among the top national and international candidates.