Job Description

Location: Steward Health Care
Posted Date: 11/4/2022

POSITION SUMMARY:

Serves as the Vice President responsible for all financial matters related to the US Family Health Plan (USFHP), the managed care plan that Steward administers for the Department of Defense. Also serves as the Vice President responsible for all financial matters related to St. Elizabeth's Health Care (SEHC), the hospital sponsored outpatient health center for SEMC. Leads, oversees and contributes to the effective administration and operational management of the US Family Health Plan and St. Elizabeth's Health Care. Provides leadership by example in promoting Steward’s values of collaboration, teamwork, participation, accountability and integrity. Provides leadership and expertise in the conception and development of objectives, plans, programs and budgets for USFHP and SEHC. Ensures that the financial management of both USFHP and SEHC are aligned with the objectives of Steward. Oversees all financial and IT aspects of the administrative services arrangement with Tufts HP, third party administrator for USFHP. This position is also responsible for coordinating the Department of Defense (DoD) National Institutes of Standards and Technology (NIST) Certification process and ensuring compliance by our subcontractor, Tufts HP.

KEY RESPONSIBILITIES:

  • Provides superior customer service to internal and external clients, customers, and patients as referenced in the Service Excellence Standards.

  • Represent the Organization in all financial related matters in regards to our USFHP contract with the Department of Defense. This includes taking the lead on the annual rate negotiation process.

  • Participates in establishing the USFHP strategic business plans.

  • Working with the USFHP Medical Director and the Tufts HP actuarial department, develop the Medical claims budget for the Health Plan. This process must ensure that the final costs are consistent with the capitation rate and achieve the goals established for the CSEMC budget.

  • In collaboration with the USFHP Medical Director, other USFHP Clinical Staff and Tufts HP, monitor the monthly performance of the plan and identify areas for improved financial performance.

  • Develop all other revenue and expense budgets for USFHP.

  • Manage the Year End Audit requirements for USFHP.

  • Manage, maintain and ensure the timely sharing of all financial information for USFHP.

  • Annually negotiates the renewal of the reinsurance program for USFHP.

  • Manage the DoD National Institutes of Standards and Technology (NIST) Certification process, ensuring compliance by our subcontractor, Tufts HP and their subcontractors.

  • Manage the following aspects of our TPA contract with Tufts HP:

- claims processing

- provider fee schedule development and adherence

- compliance with DoD monthly reporting requirements

- system change requests

- annual NIST process

  • Communicates effectively. Maintains good working relationships, works effectively as a member or leader of a team. Supports the need for communication and coordination of work across departments and disciplines.

St. Elizabeth’s Health Care (SEHC) responsibilities:

  • Provides superior customer service to internal and external clients, customers, and patients as referenced in the Service Excellence Standards."

  • Working in collaboration with the appropriate staff, develop the SEHC revenue and expense budgets

  • In collaboration with the Clinical Practice Managers, identify areas for improved financial performance of SEHC.

  • Manage, maintain and ensure the timely sharing of all financial information for SEHC.

  • Participates in establishing SEHC's strategic business, financial and operation objective by way of department budgets. Ensures that departmental budgets and resource allocations are justified. Monitors SEHC's financial performance: reviews monthly expense and utilization reports and, in conjunction with appropriate staff, implements corrective action.

  • Leads, oversees and contributes to the effective administration and operational management of general services department.

  • Working collaboratively with Steward Medical Group (SMG), the President of USFHP & SEHC, and the SEHC PCPs to develop the PCP annual compensation model. Ensure effective monitoring and reporting of these results on a monthly basis.

  • Ensures selection, orientation, training and ongoing development and evaluation of all staff. Ensures that evaluation guidelines are applied consistently and fairly across all staff.

  • Communicates effectively. Maintains good working relationships, Works effectively as a member or leader of a team. Supports the need for communication and coordination of work across departments and disciplines.

  • Appropriately maintains confidentiality of information and activates.

  • Prepares Annual goals and 90 day work plans.

  • Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.

1. Commits to recognize and respect cultural diversity for all customers (internal and external).

2. Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs and ages, utilizing interpreters when needed.

  • Performs other duties as assigned

REQUIRED KNOWLEDGE & SKILLS:

  • Exceptional problem solving skills
  • Financial experience in a managed care environment
  • Proven decision making skills and good judgment
  • Ability to manage and work with multi-disciplinary teams
  • Highly organized and multi-tasker
  • Proficiency in MD practice operations

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

  1. Education: Bachelor’s degree with a concentration in accounting or finance
  2. Experience (Type & Length): 7 -10 years in managed care environment
  3. Certification/Licensure: CPA preferred
  4. Software/Hardware: Excel, word
  5. Other: Must be able to obtain US Government OPM Determination of Trustworthiness

Application Instructions

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