Senior Vice President, Managed Care

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Senior Vice President (SVP) of Managed Care is a critical leadership role responsible for the strategic development and growth of Hackensack Meridian Health's (HMH) managed care contracting network. This encompasses hospitals, wholly owned and joint venture (JV) partner companies and employed physicians. The SVP will provide executive oversight for all aspects of managed care contracting, including fee-for-service and value-based arrangements, driving innovation in payment policy and optimizing revenue generation. This role requires a deep understanding of the evolving healthcare landscape and the ability to negotiate favorable contracts with payers while fostering collaborative relationships across HMH entities. The SVP will also champion the development and implementation of value-based contracting strategies, ensuring optimal contract performance and financial sustainability across the network. This includes overseeing underpayment and denial recovery efforts and collaborating with care management and physician advisors on continuous process improvement.

Responsibilities

A day in the life of a Senior Vice President (SVP) of Managed Care at Hackensack Meridian Health includes:

• Contract Negotiation & Network Management:

• Lead all managed care contract negotiations for HMH and its entities (hospitals, wholly owned and JV partners, and employed physicians), securing optimal terms and maximizing reimbursement.
• Develop and expand HMH's managed care contracting network, strategically aligning with payers to enhance market access and patient volume.
• Ensure network-wide consistency for value-based agreements within Hackensack Meridian Health Partners, encompassing care coordination, attribution, data submission, HEDIS quality measures, and cost management.
• Establish and maintain the infrastructure for managed care contracting across the integrated delivery system, including capitated, risk-based, value-based, and narrow network contracts.
• Ensure all contracts undergo thorough review by Finance and receive approval from HMH Legal prior to execution.
• Cultivate and manage key payer relationships, representing HMH in external vendor meetings and industry events.
• Continuously evaluate, monitor, and adjust network performance based on market dynamics and organizational strategic objectives.

• Strategy & Innovation:

• Develop innovative payer contract approaches to optimize payment and reimbursement structures, exploring alternative payment models and risk-sharing arrangements.
• Develop and implement comprehensive contract negotiation strategies, rigorously monitoring performance and ensuring successful contract execution.
• Lead the development and execution of managed care contracting policies and strategies. Monitor contract performance and proactively identify areas for improvement with payer partners.
• Foster a culture of innovation and professionalism within the managed care team, encouraging best practices and continuous learning.
• Develop innovative contract approaches that establish new partnerships and payment structures to reward improved quality, safety, and efficiency of care.

• Operational Management & Performance:

• Provide market and business intelligence to support HMH leadership decision-making, informing strategic planning and resource allocation.
• Communicate negotiation strategies and progress to senior leadership, ensuring transparency and alignment with organizational goals.
• Cultivate strong internal relationships with peer executives to ensure organizational success and seamless collaboration.
• Collaborate across the organization to develop and implement complex programs (e.g., new physician employment rate assessment and new Health Venture contracting structures) with significant financial and strategic implications. This includes active participation in planning meetings with HMH executives, Regional Hospital Presidents, Health Venture, and other business leaders.
• Oversee the recovery of underpayments and clinical denials, collaborating with care management teams and physician advisors on process improvement. Provide leadership and oversight to the Vice President, Managed Care Quality and Value Based Care and Director, Managed Care Operations to achieve optimal clinical and underpayment appeals and recoveries.

• Leadership & Team Development:

• Provide effective leadership, mentorship, and development opportunities for team members, fostering a high-performing and engaged team.
• Oversee recruitment, onboarding, training, performance management, and professional development of direct reports.
• Create and maintain a positive and collaborative work environment that promotes open communication, teamwork, and mutual respect.
• Establish clear performance objectives aligned with departmental and organizational strategic goals.
• Financial Management:
• Participate in the development and management of managed care and operational budgets, ensuring fiscal responsibility and resource optimization.
• Monitor key financial indicators and performance metrics, adjusting business activities as needed to achieve budgetary targets.
• Be accountable for achieving financial and operational goals established by senior management and approved by the board.

• Data Management & Analytics:

• Track, analyze, and report on relevant data and metrics for HMH and HMHP entities, providing actionable insights to inform decision-making.
• Develop, recommend, and implement actions or process improvements based on data analysis, driving continuous improvement and efficiency.

• Other:

• Perform other duties and projects as assigned.
• Adhere to HMH organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills, and Abilities Required:

• Minimum of 10 years of progressive leadership experience in managed care contracting within a complex healthcare system.
• Proven track record of successful contract negotiations with major payers.
• Deep understanding of value-based care models, population health management, and healthcare reimbursement methodologies.
• Exceptional written and verbal communication skills, including the ability to effectively present complex information to diverse audiences.
• Strong analytical, problem-solving, and decision-making skills.
• Demonstrated ability to lead and manage complex negotiations, achieving favorable outcomes for the organization.
• Ability to build and maintain strong relationships with internal and external stakeholders.
• Excellent written and verbal communication skills.
• Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

HACKENSACK MERIDIAN HEALTH (HMH) IS AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, breastfeeding, genetic information, refusal to submit to a genetic test or make available to an employer the results of a genetic test, atypical hereditary cellular or blood trait, national origin, nationality, ancestry, disability, marital status, liability for military service, or status as a protected veteran.

Our Network

Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.