![Great Lakes Integrated Network, Inc.](https://media.trabajo.org/img/noimg.jpg)
Director of Payer and Provider Contracting
2 months ago
Job Description
Job Description
The
Director of Payer and Provider Contracting
is responsible for developing, strategizing, and negotiating contracts with health plans for all lines of business and related product lines, as well as designing partnership opportunities to grow and develop GLIN’s high-performing, clinically-integrated network of providers.
Duties and Responsibilities
( including but not limited to )
Contract Negotiation:
Lead the negotiation process for payer contracts, including fee-for-service, value-based, and alternative payment models.
Negotiate provider contracts to ensure alignment with payer agreements and IPA objectives.
Develop negotiation strategies to optimize reimbursement rates and contract terms.
Contract Development and Management:
Develop contractual agreements with payers and providers, ensuring compliance with regulatory requirements and ACO policies.
Collaborate with legal and compliance teams to review, finalize, and execute contracts.
Monitor contract performance and compliance, identifying opportunities for improvement or renegotiation.
Ensure overall compliance for network management processes including oversight and management of the provider network, provider rosters, and payer and provider data elements.
Relationship Management:
Cultivate and maintain strong relationships with payer organizations, including health insurance companies, government payers, and other stakeholders.
Collaborate with internal departments, including finance, analytics, operations, legal, compliance, and clinical teams, to align contracting strategies with organizational goals.
Serve as the primary point of contact for payer and provider inquiries, escalations, and dispute resolution.
Market Analysis and Strategy:
Conduct market analysis to identify payer and provider trends, competitive landscape, and opportunities for partnership.
Develop strategic initiatives to expand the IPA's network, increase market share, and improve financial performance.
Monitor industry changes and regulatory developments to inform contracting strategies and risk mitigation.
Performance Evaluation and Reporting:
Evaluate contract performance metrics, including reimbursement rates, utilization, and quality outcomes.
Prepare and present reports on contract performance to executive leadership and relevant stakeholders.
Recommend adjustments to contracting strategies based on performance analysis and market dynamics.
Other duties as assigned
Qualifications or Education, Training, and Experience
Education: Baccalaureate degree in business, economics, finance, or related field
Minimum of 5 years’ experience in healthcare
contracting/analytics/network
management
Minimum of 2 years’ experience managing people, teams, and processes
Knowledge and Skills:
An understanding and application of medical billing and reimbursement
procedures/practices
An understanding of proper negotiation techniques
Excellent communication skills, including presentation of complex topics, written and oral communication skills
Strategic mindset, with the ability to develop and execute contracting strategies aligned with organizational objectives
Ability to work independently in a fast-paced environment
Ability to interact with management personnel and the provider community
Possess strong organizational skills and attention to detail
Ability to multi-task and meet multiple deadlines
Adaptive and flexible to new ideas and change
Strong supervisory and leadership skills
Excellent interpersonal and negotiation skills
Strong analytical and problem-solving skills
Ability to adapt to the needs of the organization and employees
Proven ability to prioritize tasks and to delegate them when appropriate
Proficient with Microsoft Office Suite or related software
*This is a hybrid-remote position and candidates must reside in WNY to be considered.
We offer an outstanding benefits package including health, dental, 401K, vacation, and PTO, as well as a great working environment
Pay range: $110,000. to $160,000.
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within job’s compensation range, and will be determined by considering factors including, but not limited to market data, education, experience, qualifications, and expertise of the individual and internal equity considerations
Equal Employment
Our culture encourages individual development, embraces an inclusive environment, rewards innovative excellence, and leads New York in provider and patient satisfaction. Great Lakes Integrated Network (GLIN) values diversity, inclusion, and equity as matters of fairness and effectiveness .
We are committed to hiring and retaining a staff that reflects the diversity of the communities we serve, fostering an inclusive working environment where staff of all backgrounds feel welcomed and engaged .
Great Lakes Integrated Network is an Equal Opportunity Employer
#J-18808-Ljbffr
We have other current jobs related to this field that you can find below
-
Director of Payer and Provider Contracting
1 month ago
Buffalo, United States Great Lakes Integrated Network, Inc Full timeThe Director of Payer and Provider Contracting is responsible for developing, strategizing, and negotiating contracts with health plans for all lines of business and related product lines, as well as designing partnership opportunities to grow and develop GLIN’s high-performing, clinically-integrated network of providers. Duties and Responsibilities (...
-
Director of Payer and Provider Contracting
3 weeks ago
Buffalo, United States Great Lakes Integrated Network, Inc. Full timeJob DescriptionJob DescriptionThe Director of Payer and Provider Contracting is responsible for developing, strategizing, and negotiating contracts with health plans for all lines of business and related product lines, as well as designing partnership opportunities to grow and develop GLIN’s high-performing, clinically-integrated network of providers....
-
Director of Payer and Provider Contracting
3 months ago
Buffalo, United States Great Lakes Integrated Network, Inc. Full timeJob DescriptionJob DescriptionThe Director of Payer and Provider Contracting is responsible for developing, strategizing, and negotiating contracts with health plans for all lines of business and related product lines, as well as designing partnership opportunities to grow and develop GLIN’s high-performing, clinically-integrated network of providers....
-
Buffalo, United States Allergan Full timePurpose: Provides specialist medical and scientific strategic and operational input into core medical affairs activities such as: healthcare professional/provider interactions (HCPs, Patients and Payers); generation of clinical and scientific data (enhancing therapeutic benefit and value); educational initiatives (medical education, data and value...
-
Assistant Director of Rehabilitation
1 month ago
Buffalo, United States The National Coalition of Healthcare Recruiters Full time(Only QUALIFIED Healthcare Professionals accepted) Occupational/Physical Therapy - Assistant Director of Rehabilitation - Must be either a Physical Therapist or an Occupational Therapist Direct Hire Full-Time Excellent Benefits Package Competitive Salary, based on experience Setting: Skilled Nursing Facility Location: Amherst, New York (suburb of Buffalo,...
-
Compliance Associate, Grant Contracts
2 months ago
Buffalo, United States Jewish Family Services of Western New York Full timeWHY JOIN JFS? For more than 150 years, Jewish Family Services of Western New York has been committed to providing high quality services to all in need in the interest of helping to "repair the world." Our services are guided by the essential connection between mental well-being, physical wellness, and positive self-worth. Our reputation is the result of our...
-
Director, Data Management
1 month ago
Buffalo, NY, United States Union Concrete and Construction Corp Full timeSafety Director Office Position Hourly with Overtime Application Instructions Please complete application and upload a copy of your resume and academic transcript. The Director of Safety and Health will provide comprehensive professional support to management and all employees working across the company. Responsible for leading and managing the...
-
Executive Director
3 weeks ago
New Buffalo, United States Pokagon Band of Potawatomi Ind Full timeJob DescriptionJob DescriptionPosition Summary: Under the supervision of the Gaming Commission, the Executive Director is responsible for the day-to-day operations of the Gaming Commission. The Executive Director provides administrative support to the Gaming Commission, including managing and supervising Gaming Commission staff, consultants, and contractors,...
-
Executive Director
3 weeks ago
New Buffalo, United States Pokagon Band of Potawatomi Ind Full timeJob DescriptionJob DescriptionPosition Summary: Under the supervision of the Gaming Commission, the Executive Director is responsible for the day-to-day operations of the Gaming Commission. The Executive Director provides administrative support to the Gaming Commission, including managing and supervising Gaming Commission staff, consultants, and contractors,...
-
Director of Pricing
1 month ago
Buffalo, United States Seneca Holdings LLC Full timeSeneca Holdings, the business arm of theSeneca Nation, is the parent company of the Seneca Nation Group (SNG). The SNG portfolio of companies, our federal government contracting business unit, meet mission-critical needs of federal civilian, defense, and intelligence community customers across a variety of domains. To learn more visit our website here and...
-
Assistant Director of Food Service
3 weeks ago
Buffalo, United States Metz Culinary Management Full timePositions: Assistant Director Hospital Food Service Location: Buffalo NY (relocation assistance available)Salary: 85-90K Metz Culinary Management is growing and seeking an experienced Food Service Manager to serve as the Assistant Director of Hospital Dining Services in a large and multi-outlet hospital. This position requires a solid background in the...
-
Assistant Director of Food Service
3 weeks ago
Buffalo, United States Metz Culinary Management Full timePositions: Assistant Director Hospital Food Service Location: Buffalo NY (relocation assistance available)Salary: 85-90K Metz Culinary Management is growing and seeking an experienced Food Service Manager to serve as the Assistant Director of Hospital Dining Services in a large and multi-outlet hospital. This position requires a solid background in the...
-
Regional Director of Clinical Services
2 weeks ago
Buffalo, United States Favorite Healthcare Staffing Full timeJob Description Job Description A skilled nursing facility located in Buffalo, NY is currently seeking a Regional Director to join their team full-time!Check out the details below: Title: Regional Director of Clinical Services Registered Nurse RNJob Type: Permanent / Direct HireSetting: Long Term Care Location: Buffalo, NY some travel to Albany, NY and...
-
Funeral Director/Embalmer
4 weeks ago
Buffalo, United States Carriage Services Full timeJob DescriptionJob DescriptionFuneral Director/EmbalmerAt Carriage Services, we are united by our purpose of creating premier experiences through innovation, empowered partnership, and elevated service. As a member of our team, you'll join a dynamic community dedicated to setting new standards in the Funeral and Cemetery profession. Join us on this...
-
Director of Purchasing
3 weeks ago
Buffalo, United States Curtis Food Recruiters Full timeAre you ready to drive strategic sourcing and make impactful decisions in the world of commodities? As the Director of Purchasing, you'll lead with expertise, influencing the growth and success of our operations in Upstate New York.In this role, you will:Conduct strategic sourcing events and manage day-to-day purchasing of commodity products, ensuring...
-
Provider Coordinator
2 weeks ago
Buffalo, United States Allina Health Full timeNumber of Job Openings Available: 1 Date Posted: July 09, 2024 Department: 16000640 AHCI Administration Shift: Day (United States of America) Shift Length: 8 hour shift Hours Per Week: 40 Union Contract: Non-Union Weekend Rotation: None Job Summary: Allina Health is a not-for-profit health system that cares for individuals, families and communities...
-
Provider Coordinator
4 weeks ago
Buffalo, United States Allina Health Full timeNumber of Job Openings Available: 1 Date Posted: July 15, 2024 Department: 62742500 Orthopedic Surgery Shift: Day/Evening (United States of America) Shift Length: 8 hour shift Hours Per Week: 40 Union Contract: Non-Union Weekend Rotation: None Job Summary: Allina Health is a not-for-profit health system that cares for individuals, families and communities...
-
Medical Director of Primary
1 month ago
Buffalo, United States Evergreen Health Full timeJob DescriptionJob DescriptionEvergreen HealthThe Medical Director of Primary & Specialty Care is responsible for departmental clinical leadership and oversight of providers to ensure high quality of patient care, fiscal viability, employee, and patient satisfaction. This role serves as a liaison between providers and administration leadership and will...
-
Provider Coordinator
4 weeks ago
Buffalo, United States Allina Health Full timeNumber of Job Openings Available: 1 Date Posted: July 15, 2024 Department: 62742500 Orthopedic Surgery Shift: Day/Evening (United States of America) Shift Length: 8 hour shift Hours Per Week: 40 Union Contract: Non-Union Weekend Rotation: None Job Summary: Allina Health is a not-for-profit health system that cares for individuals, families and communities...
-
Regional Director of Clinical Services
1 month ago
Buffalo, United States Elderwood Full timeSalary: $150,000 / Year Overview: $15,000 BONUS Looking to make a positive impact? Join a growing team that truly supports our caregivers. Elderwood is currently seeking a Regional Director of Clinical Services (RN) for our Assisted Living portfolio! Multi-site experience in Assisted Living Facilities required. This position requires on-site presence in...