Director, Managed Care & Employer Relations
Under the direct supervision of the SVP, UT Operations and Managed Care, position will work closely with senior Steward leadership to negotiate reimbursement rates, legal terms, performance programs, and risk arrangements with managed care plans for Steward hospitals, physicians, and ancillary providers on behalf of Steward Health Care Network (“SHCN”). Develops, manages, and sustains relationship with members of physician network to align the interests of SHCN with contracted managed care payers. Serves as a resource for the market leadership team, answering questions and providing information about network procedures or contracts. Reviews billings and claims payments according to managed care contracts.
The Director will contribute to the development of recommended tactics and objectives for negotiations that maximize SHCN financial performance and overall Steward value. The role will also serve as a mentor and manage direct reports.
- Actively participate with SVP in payer strategy development specifically the following areas:
- Clinical Integration, Patient Engagement and Population Health Management
- Advancement of clinical quality performance for hospital and physician
- Contribute to overall development and implementation of local Managed Care strategy and tactics for the applicable region to maximize Steward value.
- With guidance, execute on Steward’s vision to be a leading value-based health care system, and incorporate such vision into the overall Managed Care strategy and tactics.
- Recommend and effect direction, develop and preparation of financial and risk analysis to support the strategic goals of Steward
- Develops effective relationships with counterparts with critical payers in the marketplace into order to position Steward to be able to effectively negotiate with the payers.
- Develops effective relationships with key stakeholders within Steward, to include the SHCN Leadership, Payers, and Brokers, Hospital Division Leadership and SMG leadership, as well as other executive and corporate leadership, hospital administrators and physician leaders.
- Effectively coordinates with key internal stakeholders to advance the overall Managed Care Strategy. Creates and communicates financial and risk terms with internal and external leadership.
- Secures support for negotiation goals and positions with both internal and external constituents through strong and effective persuasive skills and technical knowledge
- Recommend models and perform monthly and ad hoc analysis for the purpose of understanding the historical, current and future performance of existing contracts.
- Works closely with the Steward hospitals and physician groups to identify systemic issues (e.g., claims, underpayments, denials) and develops resolutions that can be addressed in the contract negotiations.
- Monitors, interprets, and reports on changes in performance, market trends, health care delivery systems, and legislative initiatives that impact managed care efforts (e.g., CMS, ACO regulations, Massachusetts Health Reform, etc.).
- Provides support for the key Steward Health Care Network (SHCN) leadership meetings including: local SHCN Board Meetings, and SHCN Negotiation Committee meetings.
- Serve as resource on fiscal and legal provisions of the contracts. Coordinates closely on key contracts with local leadership and legal department.
- Define and lead resolution process with providers and health plans to address system-level claims.
- Demonstrated strong knowledge in developing and assessing risk and FFS reimbursement models.
- Understanding of the health care delivery setting including both hospital and physician reimbursement and claims processing.
- Develops, manages, and sustains relationship with brokers and employers to ensure the network has access to increased patients through aligned payer partners.
- Serves as executive team member to partner with payers to target key employers for open enrollment opportunities and maintains a pipeline of opportunities for each SHCN Chapter.
- Serves as a resource for physicians, answering questions and providing information about network procedures or contracts.
- Education: Bachelors degree or equivalent combination of education and experience; Master degree preferred.
- Experience: Minimum of five to seven years operations experience in a health plan preferably including both commercial and government programs contracting with management responsibility for those activities