Vice President, Managed Care- BJC HealthCare

Vice President, Managed Care for BJC HealthCare

Based in the St Louis or Kansas City region and under the direction of the SVP & Chief Managed Care Officer, the VP of Managed Care is responsible for developing and supporting managed care strategies and initiatives for BJC Health (East and West regions) and adapting to ongoing health care payment reforms and evolving methodologies. Manages and directs new and existing managed care payor/network agreements (e.g., commercial, IFP/Marketplace, Medicare Advantage, Managed Medicaid).  Leads and manages the staff and operations responsible for (i) managed care Contracting and (ii) Value-Based Care programs and agreements.

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.

BJC?s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children?s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.

The BJC Managed Care department includes multiple functions such as managed care contracting, financial analysis, systems and operations, value-based care and payment programs, payor and provider relations, and direct to employer solutions.

Role Purpose

Based in the St Louis or Kansas City region and under the direction of the SVP & Chief Managed Care Officer, the VP of Managed Care is responsible for developing and supporting managed care strategies and initiatives for BJC Health (East and West regions) and adapting to ongoing health care payment reforms and evolving methodologies. Manages and directs new and existing managed care payor/network agreements (e.g., commercial, IFP/Marketplace, Medicare Advantage, Managed Medicaid).  Leads and manages the staff and operations responsible for (i) managed care Contracting and (ii) Value-Based Care programs and agreements.

Responsibilities

• Collaborates with the SVP & Chief Managed Care Officer on the development and execution of BJC?s managed care contracting strategy, setting operational and financial goals, and participating in or leading specific payor negotiations.

• Contracting Team -- Manages the staff and operations responsible for the managed care contracting function (e.g., new and renewal contract planning, documentation, and implementation) and coordination with other related teams (e.g., Value Based Care/Contracting (VBC) team, Finance & Analytics (reimbursement rates), Legal, Payor Relations, RCM, etc.).

• VBC Team -- Manages the staff and operations responsible for the value based care/contracting (VBC) function (e.g., new and renewal VBC programs planning, documentation, and implementation) and coordination with other related teams (e.g., BJC/SLHS ACOs, BJC/SLPG medical groups, Finance & Analytics (reimbursement rates), BJC Center for Clinical Excellence, Legal, etc.). 

• Legal Team -- Collaborates and coordinates with the BJC Associate General Counsel from the Legal team responsible for supporting the Managed Care function, including reviewing, modifying, and documenting terms and conditions in the managed care and VBC agreements.
• Responsible for establishing annual operational and financial goals for the Contracting and VBC teams, monitoring and communicating performance, prioritization, managing staff and resources, developing staff and conducting performance reviews.

Minimum Requirements

Education

• Bachelor's Degree

Experience

• 5-10 years

Supervisor Experience

• 5-10 years

Preferred Requirements

Education

• Bachelor's Degree

Experience

• 10+ years

Supervisor Experience

• 10+ years

BJC Total Rewards

At BJC we?re committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.

• Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
• Disability insurance* paid for by BJC
• Annual 4% BJC Automatic Retirement Contribution
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

To learn more, go to our Benefits Summary.

*Not all benefits apply to all jobs

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer