We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.
Could this be you?
Integral to our team, the SVP of Payor Relations and Contracting will be accountable for creating a national strategy that defines our approach to payor partnerships across all markets and manages relationships with payors at a national level. This leader will be critical to driving successful payor partnerships through development and execution of agreements that support our business model, particularly our physician partners and patients served. This individual will be responsible for both leading and supporting payor negotiations with an emphasis on building strong, collaborative payor relationships that support innovative reimbursement structures to advance the best interest of high quality, affordable patient care.
How you can make a difference
- Provide strategic thought leadership to VMD, regarding value-based and fee-for-service contracting initiatives. These responsibilities need to be carried out with a high value placed on process buy-in, needs and reactions of constituencies, consensus, and expectation management.
- Lead all of the commercial and government contracting functions of the organization, and will be responsible for the continued developing of a portfolio contacting strategy that will support the growth the organization with a focus on value-based care
- Develop scalable team structure with regional leverage that manages local and state level health plan relationships
- Establish the department's strategic vision, objectives, and policies and procedures
- Lead the negotiation of complex, value-based payor agreements, and ownership over the strategic development and oversight of provider contracting
- Provide input to senior management and other enterprise-wide stakeholders relative to business development and strategic positioning as it relates to payer strategy
- Advise the executive team on emerging trends and methodologies in managed care contracting, payor relations and legal issues
- Pursue and develop relationships with payers and employers with regard to new payment models that support the strategic goals of the enterprise.
- Monitor relevant policy at a state and national level and assess opportunities and threats related to emerging and evolving issues
- Operate effectively in a highly integrated, matrix environment where s/he will regularly consult with colleagues and recommend plans of actions on a broad range of strategic and tactical initiatives.
- Apply current knowledge and understanding of regulations, industry trends, current best practices, new developments, and applicable laws to ensure operational and financial effectiveness. Partners to ensure regulatory compliance for all areas of responsibility
- Establish the department's vision, objectives, and policies and procedures
- Develop, implement, and maintain production and quality standards for the payor contracting department
- Partner with legal to obtain necessary TPA licenses in states where we are expanding delegation and risk services
- Develop and implement the contract structures and reimbursement methods and rates for all professional, institutional, ancillary and vendor providers
- Work closely with Operations team members to ensure that key provider support processes are optimize
- Negotiate and improve upon stop loss provisions and manage reinsurance program
- Improve deal terms for quality measures
- Partner and participate in business development efforts and initial outreach for expansion
- Form strong, collaborative, working relationships across multiple payor organizations to advance innovative reimbursement arrangements that support advancement of quality and affordability of care
Skills for success
- Ability to be proactive with strong personal initiative as well as highly organized and detail oriented
- Effectively contributing to building collaborative payor relationships that result in advantageous contract arrangements
- Understanding of medical cost trends that drive gains and losses across risk pools
- Ability to navigate within ambiguity, a service orientation, and a high level of humility are vital for successful assimilation into our highly collaborative, entrepreneurial culture
- Understanding of Medicare Advantage bid process
- Knowledge and understanding of health plan network operations preferred
Experience to drive change
- Demonstrated track record of building strong working relationships across operational leaders and potential payor partners
- Bachelor’s degree in Business required
- 10+ years in progressive roles required
- Demonstrated analytical, project management, and leadership skills
- Experience with and understanding of health care reimbursement methods,
- Experience modeling payor contracts
- Knowledge of value-based contract methodologies and preferred financial and administrative terms
- Experience negotiating quality and efficiency metrics preferred
- Ability to think independently, and develop new processes/analyses required
- Strong organizational skills with the ability to multi-task and execute against multiple competing priorities
- Proficiency in Excel, PowerPoint, and Word required