The Director, Payer Contracting consults external partners on the planning, direction, and implementation of payer relationships and provides expertise on negotiating and executing value-based contracts. The Director, Payer Contracting possesses deep marketplace expertise, serves as a strategic thought partner to key stakeholders to adjust strategies accordingly to meet high standards of contract development, contract language, drafting, analysis, and negotiation. Participates in the development of strategies and methodologies as it relates to payer contracting, contract terms, and alternatives for all contracts. The Director, Payer Contracting will provide consultative support to external executive teams on organization wide contracting efforts.Job Description:
Roles and Responsibilities
- Identifying and recommending opportunities for all forms of value-based contract performance improvement with existing customer contracts.
- Collaborating with and inspiring cross-functional teams to develop solutions, gain alignment, and deliver impactful business insights; engage necessary internal business partners to enable better decision making.
- Influencing and educating various external and internal business partners on contracting strategies, marketplace dynamics, customer insights, patient healthcare trends, portfolio considerations, and communities of practice.
- Utilizing depth and breadth of contracting and negotiation knowledge to develop and communicate managed care contract execution strategies that support clients moving to fee-for-value types of contracts
- Designing and implementing negotiation strategies for the terms and conditions in value-based contracts.
- Demonstrating executive presence (confidence, credibility, and capability), providing strategic input to and/or seeking advice from senior leaders internally and externally on a variety of topics related to managed care contracting, value-based care and risk contracts
- Owning accountability for project performance, risk management, administration, financial management and issue resolution for self-identified or assigned projects with significant scope.
- Influencing and educating various external and internal business partners on value-based contracting strategies, marketplace dynamics, customer insights, patient healthcare trends, and payer payment innovations.
- Sharing perspectives and insights to elevate team thinking and drive a balanced, holistic point of view around the movement to fee for value strategies; effectively weighing and communicating trade-off considerations.
- Educating external and internal business partners on market drivers that influence and impact work including, but not limited to, current and proposed government policy, reimbursement landscape, payer trends, distribution dynamics, and legal considerations.
- Addressing complex, strategic business issues and making decisions that have significant business impact.
- Develops and provides plan support and contracting leadership, as required.
- Compiles, maintains, and analyzes client’s value-based contracts and risk contracts portfolio for the purpose of identifying opportunities to improve contract performance and structures
- Analyzes and recommends resolutions of contract barriers, taking into account prevailing local market information.
- Performs other duties as required.
Experience, Qualifications and Education:
- Bachelor’s Degree required (general business, managed health care, legal or finance disciplines are preferred).
- Significant (7-10 years) experience in managed care.
- Significant (4-7 years) managed care contracting experience with a broad range of providers.
- Previous experience (2 -4) years of value-based care and risk based contracting. Heavy understanding of value based care is strongly preferred
- Previous (2-4 years) management or project lead experience.
- Expert Knowledge of provider contracting/negotiations, network development and configuration, standards for value-based contracting and managed care delivery.
- Substantive knowledge of population health, value-based care, managed care policy and direction.
- Strong Communication and negotiation skills.