Location: Steward Health Care
Posted Date: 4/11/2022
Under the direct supervision of the Regional SVP of Managed Care, position will work closely with senior Steward leadership to manage the payer relations and negotiate reimbursement rates, legal terms, performance programs, and risk arrangements and manage the overall payer relationship dwith managed care plans for Steward hospitals, physicians, and ancillary providers on behalf of Steward Health Care Network (“SHCN”) . The Sr. Director will contribute to the development and lead the execution of negotiations tactics to meet strategic objectives that maximize SHCN financial performance and overall Steward value.
- Contribute and actively participate with SVP in payer strategy development specifically the following areas:
- Driving risk-based Integrated system contracts balancing rate and risk provisions.
- Expanding the Value – based paradigm by establishing new deals that advance Clinical Integration, Patient Engagement and Population Health Management, and clinical quality performance for hospitals and physician
- Contribute to overall development of Managed Care strategy and tactics for the applicable region to maximize Steward value
- Lead the execution of negotiating contracts to achieve the strategic objectives.
- 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
- Recommends, directs, develops and prepares financial and risk analysis to support the strategic goals of Steward
- Develops effective relationships with counterparts with critical payers in the marketplace in 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, 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
REQUIRED KNOWLEDGE & SKILLS:
- Strong knowledge of Medicare, Medicaid and Commercial reimbursement methodologies and principals
- Demonstrated experience in building / developing and assessing risk and FFS reimbursement model
- Detailed understanding of the health care delivery with particular focus on hospital and physician reimbursement and claims processing policies and procedures.
- Strong understanding of the Texas managed care payer market and relationships with local payers or have national experience
- Education: Bachelors degree or equivalent combination of education and experience; Master degree preferred.
- Experience (Type & Length): Minimum of five to seven years managed care contracting/finance experience in a health plan or provider organization, preferably including both commercial and government contracting.
- Certification/Licensure: N/A
- Software/Hardware: proficient in Excel, Word and PowerPoint; ideally skilled in using Access
- Other: Proficient in basic math and basic knowledge of statistics and statistical calculations; strong analytical and critical thinking skills