McLaren Health Care

Director Payor Contracting McLaren Physician Partners

McLaren Health Care • $120K — $150K *
Auburn Hills, MI 48326In-Person
Healthcare
8 - 10 years of experience
1 week ago
Job Overview by Ladders

Qualifications

  • Bachelor's degree in business, health care, or related field
  • 10 years of experience in complex provider contracting
  • 3 years in a management role with direct reports
  • Familiar with standard and innovative contracting methodologies
  • Knowledge of population health and value-based contracting

Responsibilities

  • Execute contracting activities with Third Party Payors
  • Collaborate on strategic planning for contracting efforts
  • Review, redline, and evaluate Managed Care contracts
  • Lead negotiations and coordinate contract workflow
  • Develop and implement compliance-monitoring policies
  • Analyze changes in legislation and payer policies
  • Act as a liaison between health plans and MPP, MHCC and subsidiaries

Benefits

  • Ongoing professional development opportunities
  • Collaborative work environment with a focus on innovation
  • Key resource role within a major health care organization
  • Exposure to diverse contracting scenarios across market segments
  • Opportunity to influence and shape contracting strategies
Full Job Description
Supports the overall direction and coordination of Third Party Payor contracting activities within all market segments for McLaren Physician Partners (MPP), McLaren Health Care Corporation (MHCC) and its subsidiaries. Conducts contract modeling and analysis with an understanding of population health and value-based contracting, while regularly advises VP of contract performance and risk. Professionally and effectively communicates the advantages of contracting with McLaren, provides ongoing expertise throughout the contracting process and administration of payor agreements. Key team resource for MHCC and its subsidiaries, providing ongoing expertise throughout the contracting and administration of the payor agreements. Co-Manages Contracting team and monitors performance.

Essential Functions and Responsibilities As Assigned:

  1. Responsible for executing contracting activities with Third Party Payors as assigned. Collaborates on strategic planning of contracting activities.
  2. Resource for all contracting activities of MPP, MHCC and its subsidiaries, including providing ad hoc assistance and support as requested. This includes, but is not limited to review, redline, and evaluation of language of the Managed Care contracts. In addition, participates and leads negotiations, and identifies any issues and coordinates contract workflow/approval through to contract execution.
  3. Develops and implements policies and procedures to monitor contractual obligations and ensure compliance with such (i.e. annual performance benchmarks, payment rate changes, etc.).
  4. Analyzes changes in legislation, payer policies, rules and regulations impacting both facility and physician payments, including but not limited to monitoring industry developments. Communicates and educates those impacted, as necessary.
  5. Defines priorities and communicates to staff departmental goals and works with them to achieve them; seeks commitment from staff, encourages innovation and motivates through team building/planning.
  6. Acts as liaison between contracted Health Plans and MPP, MHCC, MHPN and subsidiaries, including but not limited to, research operational issues and review of payor policies needed to resolve issues.


Required:

  • Bachelor's degree in business, health care or related field.
  • Ten (10) years' experience in complex provider contracting and servicing in a managed care organization, Health System, Health Plan, PHO, PO or similar organization, including three (3) years in a management role with direct reports, leading or in all phases of effective supervision (i.e. Recruitment, performance management, training).
Preferred:

  • Master's degree in health care management, Finance or related field.
  • Experience with standard and innovative contract and reimbursement methodologies, including but not limited to fee for service, value-based payments, risk contracting, capitation and bundled payments.

About McLaren Health Care

McLaren Health Care Corporation is a Michigan-based, fully integrated health network committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 15 hospitals, ambulatory surgery centers, imaging centers, a 490-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 620,000 lives in Michigan and Indiana, home health and hospice providers, retail medical equipment showrooms, pharmacy services, and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Barbara Ann Karmanos Cancer Institute, one of only 51 National Cancer Institute-designated comprehensive cancer centers in the U.S. McLaren has 28,000 employees and more than 90,000 network providers throughout Michigan and Indiana.
Learn more about McLaren Health Care
Size
26,000 employees
Industry
Healthcare
* Ladders Estimates

Similar Jobs

Ad banner background

Get Ready For Your
Next Interview

More Jobs at McLaren Health Care

More Healthcare Jobs

Find similar Director Payor Contracting McLaren Physician Partners jobs:

NationwideAuburn Hills, MI