Healthfirst

The Senior Vice President (SVP) for DSE has responsibility for our clinical community including partner hospitals, health systems, independent physician practices, and behavioral health and non-delegated ancillary vendors. This role will serve as the lead point of contact for provider relationships as specified by the CEO. The SVP is accountable for deploying Healthfirst’s capabilities across relevant functions (product, VBR, analytics, clinical transformation, etc.) into the market through partnerships that drive value with the goal of driving best-in-class contracting strategies. The role also includes advocacy efforts with state agencies. The individual functions as a cultural ambassador and driver of initiatives that significantly improve Healthfirst’s brand and reputation in the marketplace. He/she will embody Healthfirst’s Standards of Excellence through his/her workplace behavior. He/she will also promote and reinforce subordinate behavior that is consistent with Healthfirst’s desired culture and fulfill his/her role in aligning Healthfirst’s strategic initiatives with the desired organizational culture. The Delivery System Engagement (DSE) organization plays a critical role at Healthfirst, especially given our hospital sponsorship, our critically important relationship with independent physicians and other providers, and our evolving risk model that applies across all of them. Our network is a large, complex, and dynamic ecosystem with many kinds of providers who care for our members. We interact with our sponsors and community physicians in unique ways, and together we have many interdependencies. Our goal at all times is to knit together these disparate parts of the delivery system through value-based care collaboration to improve quality and outcomes for our members. The DSE team is vitally important to Healthfirst, as is its leadership. The SVP will lead the DSE team and provide the strategic leadership for provider partnership, contracting, and engagement strategies to ensure the company is driving outcomes and meeting the needs of both the health plan and clinical practices.

This executive will define, develop, and deploy a roadmap of new solutions to support provider transformation in the market. Working with cross-functional stakeholders to align and execute the build and deployment of these strategies.  Specific SVP accountabilities include:

• Drive the design and implementation of strategic partnerships with key providers and health systems that deliver shared value, improve costs, quality, and patient experience, and support the transition to value-based care delivery.
• Design, monitor and implement products/programs to improve financial performance
• Lead a high performing team, and where appropriate, recruit strong talent with aligned vision, purpose-driven mindset, and willingness to drive transformation.
• Develop relationships that can help others understand and buy into the purpose of Healthfirst’s value-based approach, with an ability to articulate a compelling vision. Supports customers and market discussions as needed.
• Perform management responsibilities that include, but not limited to hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plans, organizes, staffs, directs and manages the day-to-day operations of the department; develops and implements policies and programs as necessary; budgetary responsibility and authority.
• Create a new process and governance structure within Healthfirst to vet, evaluate, and move forward for implementation new ideas or pilot projects that affect the delivery of care, including, for example, new models of ambulatory care such as Oak Street or Landmark, as well as pilot projects requested by hospital sponsors.  The goal is to create a “funnel” to assess these ideas through the application of a consistent set of criteria or principles, and to assist or directly execute contract negotiation, evaluation of effectiveness, and make recommendations as to whether or not particular approaches should be scaled, abandoned, or otherwise. 
• Act as subject matter expert which includes support and participation, to advance enterprise efforts with regards to  Member Attribution, Presby/H&H contracts, IPA/FQHC risk arrangements/contracts, CAIPA support, VBP and PPS relationships, outpatient rate development, HFNJ wrap up (historical);
• Develop with Marketing a Provider Toolkit that spans departments and functions and provides a roadmap for providers regarding how to interact most effectively with Healthfirst
• Execute such other efforts as directed by the CEO.

Minimum Qualifications 

• Demonstrated experience in progressive management in network management and/or an urban healthcare delivery system, although commercial provider relations experience will be considered.
• Demonstrated experience in progressive management services with strong business acumen, negotiation, financial management and analytical skills.
• Extensive experience in managed care provider contracting and network management, business systems, financial reporting, as well as legal and regulatory requirements. 

• Work experience must include senior strategic level management of large, complex organizations.
• Strategic and business transformation experience focusing on people, processes and structures.
• Bachelor’s Degree from an accredited institution

Preferred Qualifications:  

•  Master’s degree from an accredited institution.
• Strong management and leadership capabilities. The ability to establish credibility quickly and the willingness to take a strong approach to leadership and staff development.
• Demonstrated ability to work collaboratively with staff across the organization while maintaining the ability to be decisive and forthright in a consensus-driven professional environment.
• An astute understanding of Medicaid/Medicare managed care systems and urban healthcare delivery networks. Understanding the linkages between sales and marketing and provider relations in these environments. Experience working with medical claim data preferred. Managed Care, Medicaid/ Medicare and/or Hospital experience preferred.
• Experience managing multiple external and internal business processes and systems.
• Extensive knowledge of the New York City managed care market.
• Ability to provide process and technical knowledge and expertise in the areas of payment methodology, reimbursement, regulatory/compliance issues and provider contracting.
• Ability to thrive in a fast-paced, entrepreneurial environment that is continually seeking to refine and improve upon processes and systems.
• Ability to cultivate successful working relationships with primary care physicians from diverse backgrounds.
• Strong strategic leadership skills. The ability to assess the current healthcare marketplace while simultaneously setting goals and contributing to the vision that maintains Healthfirst’s competitive edge and unique marketplace niche.
• An understanding of the communities that Healthfirst serves, including the complexities of administering Medicare and Medicaid programs to patients in the current healthcare marketplace. 

• An understanding of the ancillary contracting environment, including dental, vision and prescription services.
• Ability to treat both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes satisfaction and quality.
•  Exceptional interpersonal, communication and presentation skills.
• Ability to clearly articulate goals and expectations of staff within the Network Department and their contributions to the broader work of Healthfirst.
• Ability to establish relationships with a broad spectrum of community and national healthcare professionals through presentations, meetings, conferences and associations.
• Exceptional interpersonal, communication and presentation skills. 

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.