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This is a remote position. Location preferred for candidate is in the state of TX. Candidate must have experience with healthcare payers and plan in the Texas market. The Market Director, Payer Strategy and Relationships (PSR), is responsible for managed care policies, goals and objectives related to contract language and reimbursement, negotiation strategy, and payer relationships. The Director collects and communicates Market-level insight and strategic knowledge to/from the PSR National Payer teams, the PSR Growth and nnovation team, and other key departments across the enterprise. This position is essential to CommonSpirit Health’s financial performance, and has significant impact on the long-term strategic trajectory of the organization. This position secures optimal fee for service and value-based reimbursement, protects the interests of the owned and/or affiliated hospitals/ancillaries/professional provider entities in contract negotiations, and strengthens CommonSpirit Health’s relationships with payers.
Job Responsibility
Responsible for managed care policies, goals and objectives related to contract language and reimbursement, negotiation strategy, and payer relationships
Collects and communicates Market-level insight and strategic knowledge to/from the PSR National Payer teams, the PSR Growth and Innovation team, and other key departments
Secures optimal fee for service and value-based reimbursement
Protects the interests of the owned and/or affiliated hospitals/ancillaries/professional provider entities in contract negotiations
Strengthens CommonSpirit Health’s relationships with payers
Participates in the development of Market strategy, relationships, and contracts with local and national payers
Gathers information and guidance from Region PSR VP, ministry leaders, internal stakeholders, and financial analysis
Establishes, builds, and maintains positive, strategic interactions and relationships with payers, employers, providers, and leaders
Maintains relationships with National Payer contacts with offices in the Market
Maintains appropriate Center of Excellence (COE) Designations
Develops and executes communication plans and Payer Negotiation Outlines
Makes independent decisions and/or exercises judgment
Comprehends and maintains highly detailed information
Stays current with emerging payer trends, new reimbursement methodologies, state specific regulatory issues, plan benefits, payer activity, products and delivery channels
Supports the strategic objectives of CommonSpirit Health’s IDNs, population health, and care management initiatives
Participates in and contributes to CommonSpirit Health’s PSR knowledge base
Participates in the dispute resolution and denials processes with local payers if the materiality exceeds $1M
Leads and organizes sub-projects necessary to support local and national payer negotiations and growth
Requirements
Bachelor’s Degree – equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree
Minimum of five (5) years of experience in healthcare or managed care industry
Minimum of four (4) years of leadership experience
experience with healthcare payers and plan in the Texas market
What we offer
medical
prescription drug
dental
vision plans
life insurance
paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually)
tuition reimbursement
retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings