Sr. Director, Payer Strategy and Contracting

POSITION SUMMARY :

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The Senior Director, Payer Strategy and Contracting works with the hospital management team, physician leadership and representatives from all health plans (inclusive of commercial and public payer managed care plans) to represent physician and hospital issues related to cost and utilization, quality and safety as well as strategy.

Serves as the Senior Director of the BMC Management Services, Inc. (MSO), overseeing all aspects of contracting, development and execution.

Works directly with senior leadership on strategic initiatives, operational and administrative requirements according to contractual obligations.

This role has full supervisory responsibility for a team of 2-6 contract and contract finance managers in all aspects of their work, including performance of payer contract execution.

Serves as primary contact with health plan payers and as an internal resource to and contractual expert for key stakeholders including Revenue Cycle, group practice administrators, community health centers and MSO members on contractual and operational issues.

Evaluates opportunities for improving utilization and financial performance under risk sharing arrangements inclusive of governmental payers.

Position : Sr. Director, Payer Strategy and Contracting

Department : Network Strategy

Schedule : Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES :

Managed Care Responsibilities :

• Takes lead role in developing health plan payer strategy and contracting.
• Directly supervises a team responsible for contract analysis and contract implementation / execution; duties include recruitment, hiring, firing, performance management, and professional development and training of direct reports.
• Evaluate potential contracts for financial viability and strategic importance for hospital and group practices.
• Monitors performance under existing contracts and risk sharing arrangements to identify opportunities for improvement in financial and clinical performance.

Work with hospital administration, MSO leadership and physician groups to implement improvements.

• Negotiates rates and fee schedules for hospital and physicians.
• Review contract language for legal and operational issues.
• Develop and maintain relationships with payers and potential provider partners.
• Work with cross functional teams to evaluate administrative and operational requirements in the contracts.
• Ensure that administrative guidelines and operational requirements of managed care contracts are met.
• Serve as internal contact for hospital administration, legal counsel, health centers and group practice administrators on contracting issues.
• Serve as primary contact and resource for the hospital, health centers, Revenue cycle and managed care plans on all issues related to managed care.

Medical Services Organization Responsibilities :

• Serves as Senior Director of the MSO and primary contact for health plan payers.
• Communicate the status of contracts and operational issues by facilitating the Medical Management Committee, Health Net Managed Care Committee, FPP Group Practice Administrators meeting and MSO Board meetings.
• Oversee utilization and performance under at risk contracts.
• Identify opportunities for improving performance and works with physician leadership and hospital administration to implement changes in clinical practice and medical management, inclusive of quality improvement programs, such as pharmacy utilization, case management, quality improvement and referral programs.

Finance Responsibilities :

• Coordinate the analytic work related to analyzing contract rate proposals as well as any associated contract settlement issues.
• Work with Strategy & Business Development to evaluate opportunities that would impact future business and service lines.

Community Health Centers Responsibilities :

• Work closely with Boston Health Safety Net and subsequently the community health centers and their providers on provider enrollment, contracting, operations, utilization, leakage and quality goals and objectives.
• Collaborate with the Accountable Care Organization internal team to advance the development and formation of an Accountable Care Organization.

The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job.

The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS : EDUCATION :

EDUCATION :

Bachelor's degree required; advanced degree preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED :

None.

EXPERIENCE :

At least 7-10 years of experience in healthcare or related industry is required; managed care contracting experience preferred.

KNOWLEDGE, SKILLS & ABILITIES (KSAs) :

• Comprehensive knowledge of the financial / operational requirements of managed care organizations, hospital and group practices.
• Strong interpersonal skills, a high degree of analytical ability, and the ability to work effectively with both internal and external customers.
• Strong organization and management skills, the ability to set strategy and lead a team in a fast paced environment.

Equal Opportunity Employer / Disabled / Veterans

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