Region Director Payer Strategy

Location

Rancho Cordova, CA | United States

Job description

Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

*Highly prefer candidate located in California and strong hospital negotiation experience*

*Knowledge of Revenue Cycle hospital operations*

J OB S UMMARY 

The Director, Northern California Division , Payer Strategy and Relationships plans, directs, and  implements managed care policies, goals and objectives related to contract language and rate pricing,  negotiation strategy, planning and execution, and Division and statewide payer relationship management. Negotiates division or statewide co ntracts  as part of the Northern California division’s team Northern California or statewide geogr aphy based on prior contract  performance, future growth potential and current strategic and financial goals. The division or statewide agreements may include commercial business, Medicare, Medicaid, Behavioral Health, Transplant, Workers  Comp, Veterans/Military, etc. The Director, No Ca Division serves as a subject  matter expert by collecting and communicating Provider-Specific Division-level insight and  strategic knowledge to the PSR Division Payer teams and the PSR Growth & Innovation team related to the  needs and objectives. By securing optimal fee for service and value-based  reimbursement and protecting the interests of the hospitals, owned and/or affiliated/joint venture Providers in contract negotiations and the implementation and management of managed care contracts  and relationships, this position is essential to CommonSpirit Health’s financial performance .

E SSENTIAL K EY J OB R ESPONSIBILITIES 

1. Member of the PSR Team. Participates in development of Payer strategy, relationships and contracts with these payers to further drive a clear and effective reimbursement strategy, contract renewal planning process, negotiation, implementation, and outcomes in relation to budgeted and forecasted performance and growth requirements for Providers as set forth by National and Division(s) senior leaders. 3. Gathers information/guidance from Division PSR VPs relative to the strategic, operational, financial needs and expectations of Providers in the Division.
2. Develops and maintains a knowledge-base of all CSH-employed and/or affiliated Providers across the ministry. Ensures that any/all new CSH-employed and/or affiliated Providers are added to Payer agreements. Provides subject matter expertise and guidance for provider credentialing arrangements
3. Establishes, builds and maintains positive, strategic interactions and relationships with Division or Statewide Payers, joint venture partners, employers, providers and leaders across the ministry.
4. Engages in effective communication with internal stakeholders, employed and/or affiliated physician groups across the ministry to ensure key contract terms and requirements are successfully implemented to ensure optimal contract performance and revenue expectations.
5. Develops and executes communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.
6. Analyzes and monitors financial aspects of existing managed care contracts. Utilizes analysis for feedback on contract renewals, renegotiations, payer compliance, or termination. Makes recommendations regarding participation or non-participation with new or existing agreements. Gathers feedback from ministry leaders,  Provider, and joint venture partners for PSR No CA Division team regarding financial and/or  operational issues with payers.
7. Makes independent decisions and/or exercise judgment based upon appropriate information and objectives. Comprehend and maintain highly detailed information. Accept and carry out responsibility for direction, control and planning. 
8. Stays current with emerging payer trends, new reimbursement methodologies, National regulatory issues, plan benefits, payer activity, products and delivery channels including health insurance exchanges, market competition, etc. that relate to/impact Providers.
9. Participates in establishing the composition, pricing, and management of fee and value-based payment and risk arrangements with Payers in support of CommonSpirit Health’s Healthier Communities strategy. 12. Develops, implements, and maintains value-based payment and risk arrangements in conjunction with national standards & guidelines for Providers.
10. Participates in and contributes to CommonSpirit Health’s PSR knowledge base through sharing best practices, developing contract performance goals, key metrics, network development, reimbursement and language guidelines, revenue realization, and other applicable work streams.
11. Lead/participate in the dispute resolution process for Providers with payers if the materiality exceeds $1M.

• Sys/Div/Mkt/Local Director – Required Bachelor’s Degree in related  discipline; Master’s Degree strongly preferred
• Minimum 7 years in healthcare or managed care industry.
• Significant knowledge of contractual, administrative, health insurance  and operational issues related to managed care organizations,  physician groups, hospitals and health insurance benefit plan designs.
• Proven and extensive contracting technical skills, negotiation skills,  contract preparation and implementation, financial analysis and rate  proposal development, and in-depth knowledge of various  reimbursement methodologies for both fee for service and value based contracts.
• Demonstrated ability to set and maintain multiple priorities in an  environment with shifting priorities, while providing accurate  deliverables in a timely fashion.
• Must be self-motivated, and able to take ownership of assignments  and projects.
• Strong interpersonal, verbal and writing skills in dealing with payers,  guests and team members.
• Prior experience negotiating contracts required.

PREFERRED Education and/or Experience

• Master’s in business, healthcare administration, or related field preferred.
• Previous experience in the provider or payer industry is highly  preferable.
• Highly developed communication and organizational skills. Experience assessing problems and implementing solutions.

Job tags

Salary