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As our System Director, Payer Strategy, you will play a key role in assisting with planning, directing, and implementing managed care objectives related to contract terms, reimbursement, negotiation, and key payer relationship management. This position will focus on significant payer relationships, for which you will negotiate various contract types across the organization's geographies and business lines.Every day, you will gather and disseminate insight and strategic knowledge to and from relevant teams and departments across the enterprise. This position is essential to the organization's financial performance, having significant impact on its long-term strategic trajectory. High expectations exist to secure favorable reimbursement, protect the interests of associated entities in contract negotiations, and strengthen relationships with significant payers.To be successful in your role, you will strategically guide critical payer negotiations and relationship management, directly impacting the organization's financial health and long-term strategic direction. You will demonstrate expertise in contract dynamics, an understanding of payer landscapes, and the ability to effectively communicate complex insights to diverse stakeholders, ensuring optimal outcomes and strengthening vital partnerships for sustained success.
Job Responsibility:
Leads in the development of National Payer strategy, relationships, and contracts with assigned National Payers to further drive a clear and effective negotiation strategy, reimbursement structure, contract renewal planning process, and contract implementation
Gathers information and drafts negotiation goal alignment with Division senior ministry leaders relative to the strategic, operational, and financial needs and expectations of each Division impacted by the National Payer
Establishes, builds, and maintains positive, strategic interactions and relationships with assigned National Payer(s), employers, providers, and leaders across the ministry
Documents Lessons Learned session following each renewal with their assigned National Payer with the PSR and PAE teams involved in the negotiations
Engages consistently in effective communication with internal stakeholders across the ministry to ensure key contract terms and requirements are successfully implemented
Develops and executes communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace
Works intimately with internal analytics teams
Analyzes and monitors financial aspects of existing managed care contracts and rate structure opportunities
Gathers feedback from ministry leaders on financial, revenue cycle, and operational issues with the National Payer related to contract renewals, renegotiations, payer compliance, or termination scenarios
Makes independent decisions and/or exercises sound judgment based upon appropriate information and objectives
Comprehends and maintains highly detailed information
Accepts and carries out responsibility for direction, control, and planning
Requirements:
Bachelors Other or equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree.
Minimum of seven (7) years progressive leadership experience in the healthcare environment, of which five (5) years are in managed care contracting for a hospital, healthcare system, or health plans in an intensive managed care market
What we offer:
medical
prescription drug
dental
vision plans
life insurance
paid time off
tuition reimbursement
retirement plan benefit(s) including 401(k), 403(b), and other defined benefits offerings