Job Summary / Purpose
This position is responsible for the development and management of network operations, network expansion, payer contract implementation and payer relations for San Joaquin Quality Care Network (SJQCN) and Central Valley Quality Care Network (CVQCN). The Executive Director reports to the Board of Managers, but is an employee of Dignity Health.
The Executive Director leads all operational aspects of SJQCN and CVQCN. Additionally, this position works collaboratively with the SJQCN and CVQCN Medical Directors, Dignity Health Care Network (DHCN), Dignity Health’s corporate office and local hospital quality, finance and managed care staff. Dignity Health Management Services Organization (DHMSO) will provide SJQCN and CVQCN (via a management services agreement) administrative and clinical support services. The Executive Director will be responsible for the management of the DHMSO agreement and the successful fulfillment of its terms and conditions. The Executive Director also participates in supporting the Population Health and Clinically Integrated Network (CIN) activities in the Central California Division.
Essential Key Job Responsibilities
KEY RESPONSIBILITIES & ACCOUNTABILITIES: Administration/Operations:
- Partner with SJQCN and CVQCN Board of Managers to establish networks and services necessary to successfully manage risk contracts. Support the Payer Committee in developing payer relations strategy, support local negotiations as necessary, including issues pertaining to prioritization, on behalf of the CINs.
- Work collaboratively in cooperation with DHMSO to ensure staff and employees effectively manage ongoing operations in line with driving excellence in operations and patient care.
- Ensure the integration of activities are in line with network and market-wide initiatives to drive alignment, standardization, and streamlining and increase operational efficiency.
- Ensure compliance with regulations and governing rules of Dignity Health and the Clinically Integrated Network, and contracted payers to include Federal and State payers.
- Lead with vision and create a culture that reflects a patient care-focused environment. Work collaboratively in cooperation with DHMSO staff to effectively resolve operational, staff and financial issues pertaining to the practice.
- Oversee the operations of the contractual agreements in the assigned area of responsibility to ensure they relate to strategy, execution, adherence and maintenance of effective care center and network management.
- Analyze program goals and objectives given current health care trends, make accurate short- and long-term projections to establish program needs and resource requirements; and help to identify potential sources of funds and revenues to meet those requirements.
- Partner with analytics team to develop network reporting tools to evaluate and develop actionable reports to communicate to providers regarding risk assessments and cost efficiency opportunities.
- Collaborate with DHMSO in administrative support responsibilities including creating and managing annual operating budget, hiring and management of market/network staff and efficiency of centralized operating functions.
- In collaboration with the Dignity Health Care Network (DHCN) Board, develop and implement initiatives and activities to support the overall goals of the Medicare Shared Savings Program (MSSP)
- Responsible for execution of DHCN approved and/or directed efforts to improve ACO performance
- Attends DHCN meetings and represents SJQCN and CVQCN along with Medical Director(s)
- Responsible for disseminating and communicating MSSP and/or CMS required information and materials to DHCN participants in the SJQCN market
- Collaborates with DHMF operational leadership in SJQCN and CVQCN to support DHCN efforts
- Support program communication plan and execution.
- Drive initiatives that organizationally contribute to long-term operational excellence.
- Ensure the long term financial viability of the market/network in value based agreements.
- Will cover additional networks as assigned within the Central California Division.
- Define market/network needs and gaps in current capabilities. Assess network adequacy to resolve the gaps for all provider types (acute, ambulatory and Post-acute) and build networks necessary to offer to payers and employers cost efficient quality solutions for their populations.
- Oversee physician partnerships creating a shared vision and fostering a relationship characterized by open communication, trust and the values of CINs and Dignity Health.
- Enhance, monitor and administer market/network physician incentive program payments.
- Ensure Clinically Integrated Network provides appropriate data and analytics to allow providers to effectively evaluate all aspects of the CIN performance.
- Responsible for driving change through a strong partnership and collaboration in managing VBA lives to achieve shared contractual costs and quality goals. Partnership will be with the leaders from local market IPAs, Clinically Integrated Network and Central CA hospitals and payers.
- Develop and motivate direct reports to effectively deliver upon individual and CIN objectives in an efficient and innovative manner. Recognize and reward a high performing workforce, including recognition for excellence in patient care, teamwork and collaboration.
- Lead by example and creates an environment that fosters Dignity Health's mission, vision, values and the Standards of Behavior and Conduct. Ensure management and employees are connected to how they contribute to the mission of patient care, provider support and community relations. Develop effective working relationships with key stakeholders, leaders and staff.
- Effectively lead staff and employees in a manner that engages and retains well-qualified staff. Meet with staff and employees on frequent basis to effectively and timely disseminate information, gives staff opportunity for input on solving issues; improves communications, encourages effective teamwork and positive morale.
- Effectively engage staff and employees regarding the annual employee survey, including encouraging survey participation and developing an annual action plan based upon the results to drive continual improvement of the team's engagement. Demonstrate ownership and accountability of results and sets comprehensive team goals, which could include goals for personal improvement, and ensures goals are accomplished. Ensure staff is kept updated on progress and accomplishment of goals.
- Responsible for the development of transformative risk management solutions drawing from national best practices, analytics, personal expertise and creativity to deliver value based solutions and ensure an innovative network of providers.
- Develop and lead the strategy within the broad context of the system wide landscape by using performance measurements to guide strategic and operational decision-making.
- Participate with the CINs Board of Managers and all organizational committees meetings.
- Responsible for leading and managing the key day-to-day operational aspects of market/network development, management and risk arrangements.
- Demonstrate an ability to translate strategy to operational tactics. Focus efforts on actions that will have the greatest strategic impact. Strong operational knowledgeable about the functions and processes that contribute to operational performance. Educate management and staff on healthcare and business climate changes.
Required Education and Experience
- At least 10+ years of physician network management experience or payer relations/contracting experience preferred. Managed Care Network or Provider Relations experience is a plus
- Undergraduate degree required from an accredited college or university. Master's degree in business administration or health administration or other related field strongly preferred.
- Candidate should also have relevant experience and demonstrated success in business development.
- Experience in an Integrated Healthcare Delivery System. Experience with payer relations/contracting.
- Experience managing multiple, large-scale, complex projects.
- Strong skills developing and implementing operating plans and analyzing both financial and quality data.
- In-depth knowledge of the healthcare industry.
- Strong and effective oral and written communication skills.
- Demonstrated ability to effectively manage provider relations.