JOB SUMMARY: Provides leadership in securing optimal reimbursement and protecting the interests of the organization in contract negotiations, implementation, and management of managed care relationships. Contributes to strategy implementation and negotiations with multi-market health plans and physicians to increase the value of services provided.
Responsible for the financial analysis, maintenance, negotiation, renegotiation, and management of agreements and contracts with purchasers of healthcare services.
Plans, prioritizes, collaborates and communicates information regarding projects, issues, and negotiations to ensure relationships are maintained.
Negotiates contracts with payors based on strategic and financial goals, prior contract performance, projected contract performance, and thresholds.
Analyzes and finalizes contractual language for operational and financial appropriateness.
Develops and maintains internal education communication processes and other tools to enhance contract performance, identification and compliance.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
CONTRACT NEGOTIATIONS : - Demonstrates an understanding of negotiating skills such as building trust, gaining commitment, managing the opposition and maintaining goodwill. Realizes the need for mutual concessions and accommodations and negotiates with others for resources, actions or buy-in to maximize collaborative outcomes.
NETWORKING : - Build relationships through industry contacts, professional organizations and individuals.
REGULATORY COMPLIANCE : - Demonstrates knowledge of the appropriate rules and regulations and apply them in difficult, stressful and complex situations. Able to interpret and explain rules and regulations that are ambiguous or unclear. Directs others in interpreting rules and regulations on the job and trains others in them.
COMMUNICATION : - Clearly, effectively and respectfully communicates to employees or customers.
FINANCIAL ANALYSIS : - The process of evaluating businesses, projects, budgets, etc. to determine their performance, stability and profitability.
FINANCIAL MODELING : - Building abstract representations of current and future financial situations in order to make sound financial recommendations.
Develop goals and objectives for the department based on interpretation of institutional policy and goals.
Plan to achieve goals or establish priorities.
Help department understand, share and support the vision
Initiate changes in or develop new policies, procedures and/or methods.
Analyze long-range impact of decisions and plans.
Ensure the most effective operations of the department through program development, process improvement and coordination/integration of processes with other departments.
Design, implement, evaluate and market programs to maximize clinical outcomes, functional status, patient/customer satisfaction and reimbursement.
Standardize services, processes, resources, and practice to improve efficiency.
Supervision to include responsibility for planning, coordinating, and controlling the work and procedures; provide advice/consultation to staff regarding problems
Adjust work schedules or project priorities to meet emergencies or changing conditions
Participate on departmental and/or interdepartmental committees to address problems and facilitate information exchange about programs, problems, etc. Provide information to others (oral or written) to explain/clarify problems, issues or requests.
Participate in periodic management meetings to keep top management informed of department problems and concerns
Analyze and evaluate ongoing department programs to identify areas where adjustments/improvements are needed
Develop staffing plans to ensure developmental objectives are being met.
Define and achieve financial targets in support of business goals of the institution.
Prepare an annual operating budget for a unit or department, including direct labor, material and supplies, services, equipment maintenance and replacement
Present and justify a proposed budget (operating and capital expenditure) to a management review committee
Evaluate organizational functions and structures to best determine the allocation and utilization of resources
Analyze and evaluate budget variance to determine cause,
Prepare justification or develop alternatives for cost containment/reduction
Project future budgets based upon analysis of current operations.
Create and exceed service standards utilizing key service dimension and from knowledge of patient/customer expectations and best practice.
Establish service standards for the department and determine if service standards are compatible with financial targets.
Ensure that the service standards are met or exceeded by utilizing customer satisfaction, best practices and market information to improve customer service and satisfaction.
Create an organizational culture (both within and across departments) that provides a safe, satisfying and enriching environment for employees and provides a qualified, competent staff to meet patient needs.
Provide leadership to promulgate the mission and the values of the institution to the department.
Model behavior consistent with the mission, vision, and values of the enterprise through leading, coordinating projects, innovation, initiating improvement, and developing new programs.
Demonstrate a leadership style that is facilitative and collaborative.
Communicate within and across departments to maximize effectiveness, efficiently and information sharing.
Ensures all Human Resource and VUMC policies and procedures are followed according to standards.
Define the qualifications and performance expectations for all staff positions through the Performance Development system, including department specific job descriptions, measurable performance standards.
Create an environment that encourages and supports self-development and learning for all staff through regular feedback, by assuring the development of staff through orientation, training programs, work experiences and assessing competencies by meeting the performance expectations stated in his or her job description in a timely manner (normally annually).
Identify, establish and evaluate quality assurance standards, programs, and procedures within department.
Establish and evaluate standards of performance to ensure safe, effective, and efficient operation of the department.
Ensure that standards are met within area of responsibility to assure clinical enterprise accreditation/licensure.
Internal Number: 2001680
About Vanderbilt Health
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period.Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As th...e largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.