DIRECTOR MANAGED CARE CONTRACTING - LARGE ACCOUNTS | REMOTE

This position is responsible for developing, managing, and leading the day-to-day activities associated with managed care contracting for both fee for service and risk agreements within a specified market. The work of the incumbent will be focused on developing and implementing new insurance and risk-based contracts and on evaluating, monitoring, and maintaining existing insurance and risk-based contracts. The contracts will primarily include facilities, ancillaries, physicians, PHO’s, and clinically integrated networks for a specific state where Bon Secours Mercy Health operates.

Essential Job Functions

• Leads assigned negotiations of fee for service, and value based (including risk, pay for performance) contracts for all Bon Secours Mercy Health in a specific state for Bon Secours Mercy Health. This scope of contract management will range in revenues between $500m and $1b in commercial revenues.

• Develops innovative, mutually beneficial economic and clinical alignment agreements that leverage BSMH’s clinically integrated networks and collaborates with physician and operational leadership of Pop Health.

• Employing a strong financial background and critical thinking skills, analyzes and facilitates the financial analyses and contract language negotiation for hospitals and physicians necessary to support the accuracy and profitability of fee for service and value based managed care contracting initiatives.

• Plays a key role in Payer relationships to set the stage for future initiatives and to support existing agreements, both fee for service and value based.

• Coordinate initiatives and with cross functional teams including individual markets and their leadership teams, Marketing & Communications, Finance, Revenue Cycle & Pop Health. Works closely with these groups to develop strategic plans for payers and markets including narrow network alternatives to grow attributed lives.

• Work within the markets as necessary on the standardization of processes, reporting and approaches to payer contracting, payer relationships, network participation and other strategic project from time to time.

• Participates in short- and long-term projects, as needed.

• Maintains knowledge and understanding of the current trends and developments in healthcare reimbursement and development of specific payer strategies, including investigation of new business opportunities, regulations, standards and directives regarding governmental/third party agencies (Medicare & Medicaid) and/or third paLeads assigned negotiations of fee for service, and value based (including risk, pay for performance) contracts for all Bon Secours Mercy Health in a specific state for Bon Secours Mercy Health. This scope of contract management will range in revenues between $500m and $1b in commercial revenues.

• Develops innovative, mutually beneficial economic and clinical alignment agreements that leverage BSMH’s clinically integrated networks and collaborates with physician and operational leadership of Pop Health.

• Employing a strong financial background and critical thinking skills, analyzes and facilitates the financial analyses and contract language negotiation for hospitals and physicians necessary to support the accuracy and profitability of fee for service and value based managed care contracting initiatives.

• Plays a key role in Payer relationships to set the stage for future initiatives and to support existing agreements, both fee for service and value based.

• Coordinate initiatives and with cross functional teams including individual markets and their leadership teams, Marketing & Communications, Finance, Revenue Cycle & Pop Health. Works closely with these groups to develop strategic plans for payers and markets including narrow network alternatives to grow attributed lives.

• Work within the markets as necessary on the standardization of processes, reporting and approaches to payer contracting, payer relationships, network participation and other strategic project from time to time.

• Participates in short and long term projects, as needed.

• Maintains knowledge and understanding of the current trends and developments in healthcare reimbursement and development of specific payer strategies, including investigation of new business opportunities, regulations, standards and directives regarding governmental/third party agencies (Medicare & Medicaid) and/or third-party payers.

• Adheres to the standards and policies of the Corporate Responsibility Program, including the duty to comply with applicable laws and regulations, and reporting to designated Manager (or employer hotline) any suspected unethical, fraudulent, or unlawful acts or practices.

• Participates in and encourages associates to participate in activities that benefit the community.

• Performs other duties and responsibilities as may be assigned from time to time.rty payers.

• Adheres to the standards and policies of the Corporate Responsibility Program, including the duty to comply with applicable laws and regulations, and reporting to designated Manager (or employer hotline) any suspected unethical, fraudulent, or unlawful acts or practices.

• Participates in and encourages associates to participate in activities that benefit the community

• Performs other duties and responsibilities as may be assigned from time to time.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

REQUIRED

• Bachelor’s degree in Business Administration, Healthcare Management, or closely related field
• 10 years’ experience of hospital contracting or payer contracting
• 2+ years’ experience in financial modeling and reimbursement technologies
• Previous the healthcare industry experience, including insurance, managed care, integrated delivery systems, and employer benefit plans

PREFERRED

• Master’s degree in Finance, Business Administration, Healthcare Management, Accounting, or a relatable field
• Previous experience in healthcare finance and decision support

Skills

• Strong analytical, verbal and written communication, and presentation skills

• Proficiency in spreadsheet and database programs

• Legal and contractual compliance

• Building and maintaining effective working relationships, internally and externally

• Meeting deadlines

• Data mining from internal and external sources

• Data analysis and interpretation

• Critical thinking and analysis

• Positivity and willing attitude

• Effective organizational and change agility

• Leading with influence

• Prioritization and organization

• Confidentiality

• Detail orientation, especially in context of the big picture

• Ability to work independently and collaboratively

• Proficient in Microsoft Office and other common software programs common for completion of responsibilities