Description

Position Summary:

The Vice President, Managed Care and Clinical Contracting Strategies, is responsible for the strategy, operations, and financial outcomes of UTHealth Houston's managed and value-based care functions. Leads managed care contracting, value-based reimbursement initiatives, state direct payment program (DPP) oversight, and government/county contracting. Oversees revenue integrity, provider enrollment, pricing, and chargemaster operations, Accountable Care Organizations (ACO) initiatives (e.g., CMS REACH), and the institutional contract review/approval process. Aligns departmental efforts with institutional strategic goals and drives execution.

Position Key Accountabilities:

• Develop and implement managed care and value-based reimbursement strategies, including public/private payer contracting, county/lab agreements, and DPP execution.
• Define and execute the organization's population health strategy, including bundled payments, pay-for-performance, shared savings, and ACO participation.
• Monitor healthcare business trends and competitive environments to shape payer strategy and improve financial performance.
• Direct physician contract management systems, validating actual versus expected payments.
• Launch and support new care models; track performance, address barriers, and support provider success.
• Lead and manage teams supporting contract negotiation, value-based care, informatics, and operations. Assess team capabilities and expand infrastructure to meet stakeholder needs.
• Identify and lead strategic growth opportunities involving public/private payers, providers, and third-party partners.
• Maintain and update the chargemaster in alignment with pricing policies and regulatory standards, and integrate pricing into contractual goals.
• Manage provider enrollment for all UTHealth Houston providers across Medicare, Medicaid, and commercial payors.
• Oversee revenue integrity functions, including charge capture, revenue analysis, and net revenue optimization.
• Direct the institutional contract development, review, negotiation, and execution processes. Incorporate legal and compliance considerations into contracting and payer relations.
• Evaluate and recommend enterprise-wide business development initiatives, including partnerships, acquisitions, and network expansions.
• Develop revenue projections and financial proformas in coordination with finance based on contract terms, payor mix, and new lines of business. Adhere to internal controls and institutional reporting structures.
• Manages Human Resources activities for direct reports in regards to: recruiting and selection; hiring and termination, training, development, mentoring, counseling, performance evaluations, and salary planning.
• Responsible for the design, execution and effectiveness of a system of internal controls which provides reasonable assurance that operations are effective and efficient, assets are safeguarded; financial information is reliable and compliant with applicable laws, regulations, policies and procedures.
• Performs other duties as assigned.

Certification/Skills:

• Extensive experience in managed care, healthcare contracting, and value-based care strategy.
• Deep understanding of public and private payer systems and reimbursement models.
• Strong leadership in managing physician group operations within health systems.
• Proven ability to lead various teams and manage cross-functional initiatives.
• Experience with large-scale transformation, change management, and healthcare informatics.
• Advanced analytical, negotiation, and communication skills.
• In-depth knowledge of reimbursement methodologies (DRG, APC, CPT, RVU), healthcare finance, and regulatory compliance.
• Skilled in EMR systems, data-driven decision-making, and virtual team leadership.
• Ability to manage complex stakeholder relationships and drive results in dynamic healthcare environment
• Experience in Change Management

• Master's Degree in Business or Health Care Administration required

• 10 years of experience with contract negotiation for physician services required
• 5 years of experience in senior management with supervision of healthcare finance/managed care preferred

• Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Employees must permanently reside and work in the State of Texas.